Workers' Compensation Perspectives

How does the workplace have to change because of the aging boomers?

2012-02-06T12:13:00.001-08:00

Last week I participated in a CBC series entitled, "The Silver Ceiling". The overall series concept was driven by the leading edge of the baby boom generation hitting 65 this year. My contribution was to speak about how workplace safety and health in light of this demographic shift.

As we age (and as many of us know first hand) our bodies change. Our eyesight and colour perception change beginning in our forties and fifties, muscle strength and hearing acuity decline, and co-morbidities such as high blood pressure and diabetes increase. Obesity is also associated with age. Reaction time slows and recovery times increase.The need for medications often increases and with these often come side effects such as drowsiness.

But it's not all bad news. We certainly gain experience as we age. That experience and knowledge allow us to avoid many of the risks in workplace environments.

How should the workplace change? I'm not suggesting radical steps. Improved task lighting, for example, will allow aging eyes to work more comfortably. Removing clutter from control panel designs to shop bench workstations will prevent errors that may cause injury. Improving ergonomics by limiting weights, supplying lifts (and the training and support so they are actually used), increasing the font size on signs, reducing tripping hazards through high contrast step edges, adding handrails — all of these changes are low cost adaptations that can improve workplaces for all workers not just aging boomers.

I believe we'll see more and more older workers in the workplace. I recently downloaded data from Statistics Canada’s Labour Force Survey that demonstrates a fundamental shift in workplace demographics that I believe will continue for years to come. The following chart shows the number of workers in the B.C. labour force who are younger (under 25) and older (aged 55 and older). The largest core of workers is aged 25 to 55 and is not shown on the chart but as you can see, older workers now outnumber younger workers in the BC employed labour force.

I’m not the only one who is predicting that we'll see more older workers in the labour force in the future. We don’t have enough young people to replace those that are retiring so many older workers will be enticed to work longer. Some will have to work longer for financial reasons but most will want to work to some degree because research has shown, work is good for you. Even if older workers want more flexibility so they can travel and enjoy family, many will also want an opportunity on a part-time basis to be engaged in the labour force, and use the skills and knowledge they've developed over a lifetime.

I gave about a half dozen interviews on this topic and one interviewer turned the question around and asked what older workers can do about their workplace health and safety. The traditional advice still stands: eat right, get plenty of exercise, get regular check ups, etc. Be aware of changes in your body, the effects of aging, age-related health conditions, and the effects of medications you may have to take. When you think about it, that advice applies to everyone.

Why should we care about a privatization proposal for another workers’ compensation fund?

2012-01-23T11:58:00.000-08:00

The idea of privatizing workers’ compensation state funds comes and goes regularly. West Virginia’s state fund (BrickStreet), and Nevada’s state fund (Employers Insurance Company of Nevada, Inc. or simply Employers), are recent examples of this trend. In Colorado, Pinnacol, the state workers’ compensation fund is the latest subject of a privatization proposal.

Pinnacol is a competitive state fund. Most state funds are “competitive” but North Dakota, Ohio, Washington, and Wyoming operate as “exclusive” (monopolistic) state funds. All Canadian workers’ compensation systems are similar to this latter group. Pinnacol has 55,000 employer/policy holders, covers about a million workers (57 percent of the market), and is the “insurer of last resort” in Colorado. Pinnacol is the fourth largest of the 25 state funds in the U.S.

At present, Pinnacol is a state entity. The proposal is for Pinnacol to separate from the state and become a “mutual insurance holding company”. The proposal was submitted to the governor in November with the support of Pinnacol’s board of directors and CEO. Under the plan, Pinnacol would be owned by its policyholders (the employers who pay the premiums) although it could be demutualized and become a shareholder-owned and traded corporation at some point in the future.

The advantages for Pinnacol include autonomy from government, the potential to expand market beyond the borders of Colorado, and (suggested) improved value to policyholders. For government, the positives include the creation of a taxpaying entity, a 40 percent stake in the new company, and dividends the state could use as much needed revenue. Denver Post blogger Tim Hoover has gone so far as to say that failing to privatize Pinnacol would be a costly mistake.
Reaction to the proposal is not all positive. A report in the Denver Business Journal suggests many businesses are reluctant to back the plan. According to the Northern Colorado Business Report, one obvious concern is over rates. Privatizing would change Pinnacol’s tax-free status and this alone could put upward pressure on rates.

I strongly believe every state has the right to determine what’s best for its own jurisdiction. There are many examples of well-performing private insurers, competitive state funds, Canadian workers’ compensation boards, and exclusive state funds that deliver excellent value to both workers and employers. That said I have seen no compelling study that shows private provision of workers’ compensation insurance delivers lower employer cost or better results for workers, than existing Canadian workers’ compensation boards or U.S. exclusive state funds, particularly over the long run. The one good study on the topic found a slight advantage in terms of employer cost when provided by exclusive funds (but because of data limitations, the study’s authors concluded there was no clear difference between exclusive and private provision).

Privatization is a one-way solution. While I can recall Hawaii (1996) and Maine (1993) creating new workers’ compensation state funds (HEMIC and MEMIC) in private workers’ compensation markets, I can’t recall any private insurers being bought out or taken over by a state (on an ongoing basis). The drivers in one jurisdiction may signal “coming attractions” for another.

Privatization is often proposed as a quick fix for what are usually more fundamental issues. Access to insurance, competitive rates (often related to funded status and sustainability), cost control, and improved service top the list of drivers behind many proposals to change models. Every workers’ compensation insurer — private, public, competitive or other model — needs to keep an eye on its performance on these important dimensions.

What is the true incidence of work-related disease?

2012-01-10T10:24:00.000-08:00

The following story from New Zealand (NZ) caught my eye:

New figures reveal work kills 1000 a year
(by Tom Hunt, Fairfax News, 19/12/2011)

Work is killing 1000 of us a year.
New figures, which also show there are 17,000 new case [sic] of work-related disease in New Zealand each year.

Think about that for a minute. New Zealand is a country with a population of 4.3 million — almost identical to the population of British Columbia — yet work-attributed fatalities and diseases in NZ far exceed those we accept at WorkSafeBC. What accounts for the difference?

When I tracked down the source report for the headline, the reasons became clear. NZ is taking a holistic approach to the issue of occupational illness: on a population basis, the incidence of occupational disease that can be attributed to work will always be greater than incident rates calculated from individual cases where causation must be adjudicated.

On a population basis, NZ finds:
about 700–1,000 deaths occur every year in New Zealand from occupational disease, particularly cancer, respiratory disease and ischaemic heart disease (such as coronary artery disease) 2–4 percent of deaths of all people over the age of 20 are due to occupational disease, and 3–6 percent of all cancer deaths in people aged 30 or older are due to occupational cancer
there are about 17,000–20,000 new cases of work-related disease every year.

What the population-incidence approach illustrates is that workers and society are paying a huge price for work-related illness and disease. If B.C. has a similar population-incidence ratio then the true cost of work-related disease is far greater than the 2,750 occupational disease claims first accepted and paid in 2010.

Leaving aside the under-recognition and under-reporting of many occupational diseases, this high incidence alone requires action. The NZ Action Plan proposes a focus on five specific hazards:
• occupational carcinogens;
• respiratory hazards;
• noise;
• skin irritants; and
• psycho-social hazards.

Exactly what actions will be taken to address each of these hazards will depend to some extent on the sector. To assess whether any of the actions has been effective will require data on exposure to health hazards in the working population. NZ is actively developing a surveillance system through the Centre for Public Health Research at Massey University.

Recognizing the true incidence of occupation disease changed the dialogue in NZ. The focus is not on claims costs but human and societal costs. More importantly, there is a refined focus on prevention rather than jurisdiction. It will be interesting to see how their strategy and surveillance systems develop. There may be important lessons for other jurisdictions.

Who creates disability?

2011-12-07T11:29:00.000-08:00

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.

Why should we care about research?

2011-11-24T09:57:00.000-08:00

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.

What constitutes an emerging OH&S risk?

2011-11-10T08:24:00.000-08:00

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?”

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

2011-10-26T19:50:00.000-07:00

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.

Have Occupational Injury Rates Stopped Falling?

2011-10-08T05:05:00.000-07:00

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.

What happened at the IAIABC Convention – Part 2

2011-09-27T04:28:00.000-07:00

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.

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

2011-09-15T08:41:00.000-07:00

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.

2011-09-15T06:57:00.000-07:00

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."

What can you learn from an old name tag?

2011-09-08T04:18:00.000-07:00

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.

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.

Is the centenary of workers' comp worth celebrating?

2011-08-03T02:27:00.000-07:00

Workers’ compensation in its present form is a concept that is about 100 years old in North America. Germany celebrated the 125^th 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 125^th 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?

2011-08-03T02:18:00.000-07:00

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.

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

2011-07-07T01:47:00.000-07:00

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"][/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—34	Ages 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.

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

2011-06-02T02:34:00.000-07:00

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.

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

2011-05-17T03:11:00.000-07:00

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.

Will changes to CPP alter retirement and working patterns?

2011-04-15T08:12:00.000-07:00

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

Is the blitz an effective prevention technique?

2011-03-25T02:47:00.000-07:00

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.

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

2011-03-04T05:17:00.000-08:00

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.

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

2011-02-18T06:14:00.000-08:00

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:

Summary Requirements for Reporting a Claim

Penalties for Delay in Reporting (General)

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.

Are there any great OH&S apps?

2011-02-07T02:59:00.000-08:00

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!

How does new safety technology protect workers?

2011-01-17T01:27:00.000-08:00

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?

2011-01-17T01:23:00.000-08:00

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: http://www.labour.gov.on.ca/english/hs/eap/report/index.php

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.

Are the costs of workers’ compensation funded solely by employers?

2010-12-07T01:11:00.000-08:00

I am not often asked, “Who pays for workers’ compensation?” because most people think they already know the answer. Most people think employers pay the full cost of work-related injury, illness and disease through premiums paid to a workers’ compensation insurer. The true costs, however, are borne much more widely.

Workers pay the biggest price. The loss of health, function, range of movement and even life itself is a huge cost that must be figured into the equation. Families, friends, dependents, community members, and neighbours also bear the costs in terms of tangible losses in their lives. In some provinces and states, workers also have to bear the first few days (for example, two-fifths of a week in Nova Scotia, three days in Washington State) as a waiting period.

In some jurisdictions the costs are also borne in part by the state. For some cases, the appeal structures, prevention programs, rate approval authorities, insurance commissioners, advocacy and ombudsman offices are often paid out of general revenues of the state or province. Certain states fund these, in whole or in part, by direct assessments over and above the premiums charged to employers.

In Oregon, for example, a charge of $0.028 (just under three cents) is collected from workers and employers for every hour —or part of an hour— worked, to fund cost-of-living increases to permanent disability and survivor recipients. The workers and employers split this charge; workers generally pay this as a payroll tax or deduction and the employers match and remit the total to the state. To augment federal funding, the state’s Occupational Health and Safety program assesses employers a straight 6.4% premium tax (2011; up from 4.6% in 2010).

New Mexico assesses workers $2.00 and employers $2.30, per quarter, to fund the operation of the New Mexico Workers’ Compensation Administration (WCA), which regulates, adjudicates, and provides education and assistance services to the workers’ compensation system.

California recently announced its assessments for 2011 as follows:

WC Administration Revolving Fund Assessment/User Funding 0.014721

Uninsured Employers Benefit Trust Fund Assessment 0.004101

Subsequent Injuries Benefits Trust Fund Assessment 0.001776

Occupational Safety & Health Fund 0.002467

Labor Enforcement & Compliance Fund 0.002315

WC Fraud Account Assessment 0.004348

That totals 0.029728 or about 3% in assessments paid as a tax on premiums. Self-insured employers have to pay assessments that currently total about 5.5%.

Employers in many Australian jurisdictions are responsible for the first week or two of wage-loss benefits—a kind of employer deductible—and the first $592 of medical costs.

WorkSafeBC has no waiting periods, no employer deductibles, and no additional assessments over the published rates. Workers still bear the cost of injury, loss of function, perhaps visible scarring or invisible pain. Employers nominally pay the premiums but ultimately workplace injury, illness and disease are borne by all of us in the prices of goods and services we consume, the productivity of our workforce and even our standard of living. We all bear some of the costs… All of us bear the responsibility to make work-related injury, illness, and disease unacceptable.

Does a vision statement really mean anything in a workers’ compensation organization?

2010-11-26T01:50:00.000-08:00

Most public and private organizations have a corporate “vision” statement. Some people view the creation and use of a vision statement as another one of those things you are supposed to do that doesn’t really matter on a day-to-day basis. If the vision statement is simply a perfunctory piece of prose, then it is dispensable. On the other hand, if the vision statement is truly a shared conception of the ultimate future your organization is striving for, then a vision statement is a crucial element of your strategy.

Working in Corporate Planning, I get to look at a lot of vision statements. Some vision statements are famous. Jack Welch, the former CEO of General Electric lead his organization with the following vision statement “To become the most competitive enterprise in the world by being number one or number two in every business in which we compete.”

Other vision statements are less transformational and more directive. Hewlett Packard has the following vision statement:

"To view change in the market as an opportunity to grow; to use our profits and our ability to develop and produce innovative products, services and solutions that satisfy emerging customer needs."

Amnesty International's vision is of “a world in which every person enjoys all of the human rights enshrined in the Universal Declaration of Human Rights and other international human rights standards.”

Vision statements can certainly be inspirational and are usually aspirational—a state that is wished for involving a stretch from the present. Workers’ compensation systems generally get their mandate from legislation but it is the leadership (usually the board of directors) that establish the organization’s vision. WorkSafeBC’s vision statement clearly fits the inspirational/aspirational category:

“Workers and workplaces safe and secure from injury, illness, and disease”

It is certainly aspirational (we aren’t there yet) and is very descriptive of the world we are striving for.

WorkSafe Victoria is focused on the worker: “Victorian workers returning home safe everyday”.

WorkSafeMT "... envisions a future without injury, illness and fatality in Montana's workplaces"

If you really believe in that vision, then the programs and initiatives you design will be aligned with and contribute to that vision. (If an initiative does not align, you really have to ask “Why are we doing this?”)

These last three vision statement are very different from WorkCover Queensland’s vision “To excel in workers’ compensation insurance” and WorkCover Western Australia’s vision “ A workers’ compensation scheme valued by all.” When you think about these two vision statements, the programs and initiatives you might design will likely have different features and emphasis than the previous three.

Vision statements crystallize the future state of nature your organization is working toward. Actually getting there requires commitment, goals, objectives, strategies and programs (including projects and initiatives). Each part of the organization has its own mission with its own plans and projects that are aimed at contributing to the overall strategy. Aligning vision, mission, strategy and actual operations is critical to performance.

If you have a favourite vision statement, post it and tell us what makes it great.

Aren’t "Safety" and "the Absence of Injuries" the same thing?

2010-11-15T04:40:00.000-08:00

In the last 30 years, I have probably been asked this question in one form or another about a hundred times. If you think the question is just playing with semantics, you might want to think again. In workers’ compensation and occupational safety and health terms, "safety" means control of recognized hazards to achieve an acceptable risk. The "absence of injury" is a pretty straightforward and seemingly concrete concept. It is supposed to mean that workers involved in a process have not been injured. It sounds objective because we can count injuries. If injuries amount to zero, one might be tempted to say the employers and workers involved in the process have been working safely. This might or might not be true.

The first problem is the definition of injury. Most of us would accept that the amputation of an arm is an injury—a reportable, recordable, countable work-related injury. Perhaps fewer would classify a slice of an index finger that requires no stitches as a reportable injury or recordable injury. As you can see, how you define injury or what you qualify as a reportable or recordable injury may change what you mean by the absence of injury and what that implies about safety.

And therein lays the second problem: even with a broad and agreed upon definition of what constitutes a work-related injury, the absence of injury or a low count of injuries may say little or nothing about safety. When a piece of plate iron drops and strikes a worker’s foot, the only difference between a broken little toe and an amputated foot may be a matter of centimetres. In order for the iron plate to injure the worker, there was likely a failure in design, work procedures, supervision and training. In most such cases, it takes a defect in each of these safeguards and an alignment of these defects that results in the worker being injured. It is in examining the injury trajectory that safety (or the lack thereof) can be determined. The truth is, most unsafe work situations do not result in injuries; an injury may provide a reason to determine the defects in the safe work procedures, design, supervision and training/education that existed before the worker was harmed.

"Safety" and "the absence of injuries" are not synonymous terms. Any well-run safety program is going to want to know about all the injuries and all the near misses but more importantly, will be focused on the leading indicators of safety (adherence to safe work procedures, identification of hazards, interactions with specific safety-oriented content between supervisors and workers, etc.). The investigation of injuries and near misses will reveal where the defects were (and maybe still are) and how they aligned to allow a hazard to reach through the safeguards and barriers to harm the worker. Fixing the active and latent defects in the barriers, defenses and safeguards will arguably increase safety.

Safety is not fall protection or Personal Protective Equipment (PPE) or any other piece of equipment or protective gear. Safety is not the absence of injury (although effective safety is intended to have that result). Safety is an attitude, a disposition, a belief, a value. Safety is maximized when the defects in the design, safe work procedures, supervision, and training/education are minimized. It is because safety and the absence of work-related injury, illness and disease are not the same thing that prevention continues to be our top priority.

How would you design a completely new workers' compensation system?

2010-10-25T03:24:00.000-07:00

I was asked a few weeks ago how I would design a workers’ compensation system. I’ve actually given this a lot of thought over the years and have come up with some principles that I believe would optimize a new workers’ compensation system in a society similar to the Canadian context.

Before you even glance at the following statements, let me make one point crystal clear. I am not advocating any existing system change to adopt any of the following items. This is just a conversation starter intended to help in a ‘green field’ exercise. Each item in the list is in some way dependent on others so the list is intended to be applied in its entirety to a hypothetical jurisdiction.

Remember, these are my personal opinions based on my own experiences and observations; these items are not intended to be a statement of direction for WorkSafeBC or a prescription for any other existing system.

Let me also add that each item here could fill pages of discussion and analysis. I would be happy to discuss any one of them.

Finally, the list is not comprehensive. There are lots of other items that I would add for the design of a complete system but that is beyond the scope of a personal blog.

Keeping that in mind, here are my top dozen design criteria/features for such a hypothetical new workers’ compensation system in a society similar to Canada:

1.       Prevention orientation: This has to be at the top of the list. Employers would be required to report all work-related injuries to the agency within three working days.

2.       Universality: Every worker and employer should be within the scope of coverage… and all work-related injuries, illnesses and diseases should be included within scope. This takes away workers’ rights to sue but creates a comprehensive no-fault coverage system.

3.       Integrated: Given the universality of coverage, it makes sense to combine and integrate the compensation and prevention (consultation, education, promotion and compliance enforcement) functions. It also makes sense to have the rate-making and financial authority integrated into this model.

4.       Accessibility: workers and employers should have instant electronic access to information about their claim or claims, be able to communicate, and transact all business with the workers’ compensation insurer without temporal, language, bureaucratic or other barriers.

5.       Actuarially based: full funding (capitalization of costs) for injuries should be maintained by injury year (premiums should cover all incurred costs including prevention and future administration).

6.       Comprehensive: All medical diagnostic, treatment, and rehabilitation (physical, social, psychological and vocational) should be covered. This ensures that the costs of injuries are born by industry and not the taxpayer. It also is consistent with the current Canada Health Act, which does not include payments made by a workers’ compensation system in the definition of an insured health service.

7.       Supporting of the worker-employer relationship: all claims of less than 8 weeks should be paid directly to the worker by the employer (at the prescribed rate). The employer would be reimbursed by the workers’ compensation agency dollar-for-dollar for all wage-loss benefits paid to the worker through week six of the claim.

8.       Supportive of complete claims reporting: Experience rating would not apply to claims of less than 8 weeks duration; this creates an incentive for firms to report all injuries (employers get to recover what they spend on wage-loss benefits they paid the worker) while retaining the experience rating that most employers feel adds a fairness to the system for those with poor performance.

9.       Encouraging of early and safe Return-to-Work: Employers will be directly responsible for wage-loss costs payable in week 7 and 8 of every claim. Experience Rating will apply for claims of greater than 8 weeks duration. These features provide incentives for early return to work and accommodations consistent with Disability Management procedures.

10.   Value the injury of all workers equally: Experience rating based on duration of disability not cost. This avoids the criticism that most experience rating systems are cost-driven and thereby devalue injuries to low wage earners.

11.   Compensate long term claims equitably: Permanent Disability (not impairment) to be roughly comparable for workers with similar age, gender, education, industry, and occupational backgrounds relative to their counterparts without work-related injury.

12.   Credibility and independence in all classifications: Pools of firms with similar risks should be self sustaining for the costs they incur. Very limited possibilities for cross subsidization and re-insurance.

I repeat, these features are the general parameters and very brief rationales for a new system and are not intended to be a roadmap for reform of any particular system. Any system is a product of its history, societal values, politics, and even geography. The present design of any system is responsive to a particular environment. I am not injecting these ideas into any particular reform process.

I have conveniently left off how dispute resolution mechanisms would operate, how premium rates would be established and what one would do with exceptional cases (this is only a blog post, not a thesis).

Perhaps you have your own ideas. I would be interested in how you would design a system if you were starting from scratch.

What drives Duration... and what can we do about it?

2010-10-19T05:49:00.000-07:00

Duration of disability is a complex measure within workers’ compensation systems. Duration has natural drivers such as age (it takes longer to recover as we get older), injury type (more severe injuries take longer to recover), and even obesity (obese of workers as a group take longer to recover than non-obese workers with similar injuries) can drive duration higher. We can’t do much about these drivers once an injury takes place.

After an injury, there are some things we can do to speed recovery and militate against excessive duration. We have strong disability management programs that can speed return-to-work (assuming the programs are well staffed, the staff well trained in DM principles, and stakeholders are willing to support DM efforts). There are guidelines for expected recoveries and programs that encourage early and safe return to work (research literature shows that work is actually good as therapy and contributes rather than works against good health). Medical science and physiotherapy have advanced dramatically over the last century and each of these can contribute to more rapid recover and return-to-work outcomes.

External factors put pressure on duration. In a slowing economy, durations tend to rise. This makes sense since workers not on wage-loss benefits are likely in a position to carry some of the extra load at no direct or current cost to the payroll. Rising and hot economies tend to contribute to shorter duration. Workers are enticed to return to work and are more likely to be accommodated by their employers in these circumstances.

Access to healthcare can also delay recovery. If it takes a year to get an MRI and six months to see a surgeon, you can bet that duration statistics will rise.

Despite these factors, it appears some general measures of duration of disability from work-related injury have remained remarkably stable over time. In Sir William Meredith’s Final Report, Meredith muses “…it may, I think, fairly be assumed that the great bulk of the accidents for which compensation would be payable under the proposed law will incapacitate the workman for short periods—84 per cent probably for less than fourteen weeks.”

I looked at WorkSafeBC claims with an injury date in 2008 where there was at least one day away from work. WorkSafeBC pays wage-loss benefits beginning the day following the day of injury so our way of counting may not fully match with Meredith’s assumption. That said, his projection looks pretty good— 85.14% of time-loss claims with an injury date in 2008 had durations of less than 14 weeks.

One factor contributing to the relative stability of duration is the common denominator of human biology and physiology. Healing times have not really changed over the last 100 years for many conditions. Fractures still take the same time to mend; lacerations take about the same to heal. Yes, we have antibiotics and new technology. These save lives. Many victims of severe injury would not have survived in Meredith’s time. They survive today… but their recovery and return to work can take a lot longer.

I’ve also looked at duration by age category. Over the last couple of decades for which I have data, the average duration for 20-24 year olds or 35-40 year olds has barely changed. What has changed is the demographic mix with older workers now dominating the distribution of injured workers. This change in mix is another factor that will continue for some time to put upward pressure on duration.

Of all the factors listed, effective disability management is the leading candidate to counter the upward pressures on duration.

What can we learn from German Premium rates a century ago?

2010-10-19T05:47:00.000-07:00

Premium or Assessment Rates in workers’ compensation are a unique comparator. Because they are normally presented in North America and Australia as $x.xx per $100 of (assessable) payroll, it is trivial to convert this to a standard percentage (x.xx%). A percentage is independent of currency so it is possible to compare jurisdictions in different countries without worrying about exchange rates.

Time series of assessment rates may also tell a story. Since rates are ultimately based on incurred costs, rising rates usually indicate rising costs within the sector covered by the premium or assessment. This holds true for most systems. For example, rates may rise if experience shows that injuries are resulting in increases in severity. Other explanations are also possible.

I recently resurrected some notes I had copied from Sir William R. Meredith’s Interim Report on Laws Relating to the Liability of Employers (1912). In that report is a table of Premium rates for employers in their industry ‘mutual funds’. As you may recall, the German system at the time consisted of employer mutual insurance funds for workers’ compensation organized by sector. Bismarck proposed the system in the early 1880s and the time series in Meredith’s interim report covers the period 1886 to 1908. Many of the rates changed over the time series. This is understandable because the first year would have been an estimate. Over time, as experience was gained, more accurate estimates of cost could be made. This would lead to more accurate premium rates.

Meredith notes that the German rates include a nine to ten percent margin above the cost rate to establish reserves funds to cover unforeseen contingencies such as “the entire wiping out of the industry or its inability to meet its payments in a period of financial depression”. There is a lesson there for many systems.

How much have things changed since then? The following chart lists the Assessment Rates for Germany for selected sectors in 1886 and 1908 (bars) with the current (2010) WorkSafeBC premium rates (points connected with a line).

Looking only at the German rates, one can see that most rates rose over the first two decades. By comparison, using our modern classifications with some adaptations (like substituting ‘Aircraft Automobile Assembly’ for ‘Carriage factories’), about half the rates are near or below their German counterparts’ 1908 levels. This is understandable with respect to some sectors such as sawmills where technology has made amazing progress in terms of safety and health. Other sectors have increased in costs. The explanations here might relate more to increases in scope of coverage (to include occupational diseases such as asbestos-related conditions in shipbuilding).

Comparing systems is always problematic and comparing different systems more than a hundred years apart is an admittedly dubious enterprise. It is natural, however, to ask how the rates of one system compare to another particularly at the industry level even if widely separated by time; most of us need that perspective as a starting point. What surprised me was that premiums today are not drastically different than they were a century ago. I don’t believe that the cost of workplace injuries should be considered merely a cost of production. That said, what is striking about the chart is how similar the range of rates appear.

What were the hot topics at IFDM and IAIABC?

2010-10-19T05:39:00.000-07:00

A few weeks ago, I attended the International Forum on Disability Management (IFDM) and annual convention of the International Association of Industrial Accident Boards and Commissions (IAIABC) in Los Angeles. This was a great opportunity to hear from other systems about the hot issues, successes and challenges facing systems in the US and other jurisdictions. The following is sampling of what I heard:

Dame Carol Black spoke about her review and report of the UK system for compensating for work injuries. She has been instrumental in changing the focus in that country to conform to the principles of Disability Management. It was fascinating to hear how engrained the system of ‘sicknotes’ was in legislation and practice. As simple and fundamental as it may seem to us, the move away from this terminology to ‘fit notes’ and a focus on ability has been a big challenge for the country and the transition is still underway.

The German Social Accident Insurance system (DGUV) is celebrating its 125^th year as a Bismarckian workers’ compensation system. It has also undergone a major consolidation from more than twenty industry-specific mutual systems to nine. They are also facing the same sorts of issues we are seeing in North America including a rising tide of occupational diseases and an increase in psychological injury cases.

In New Zealand, the Accident Compensation Corporation (ACC) is a relatively young system of just 34 years. It covers work and non-work injuries that involve lost earnings. Interestingly, the change in accounting standards (known as IFRS) is creating a new challenge for the system that is driving a lot more attention on long-term claims. The new accounting standard requires the government to carry the expected lifetime cost of claims as a liability.

Munich Re, the largest reinsurer highlighted its major concerns for the future. Its criteria acknowledge risks like nanoparticles and nanotechnology but did not list them because they cannot yet quantify a cost impact. Of the items that they can make some estimates on, obesity, the aging labour force, the use of temporary foreign workers, psychological injuries, and long latency occupational diseases topped the list.

On the IAIABC side of the agenda, a presentation from the National Council on Compensation Insurance (NCCI) highlighted obesity. Their economist concluded that there were marked differences in outcomes for obese and non-obese workers who sustain similar work-related injuries. Their analysis of members’ workers’ compensation claims found that injuries sustained by obese workers are more likely to result in permanent disabilities and the range of medical treatments and costs are greater for obese claimants.

Tungsten Inert Gas (TIG) welding was highlighted by the IAIABC as an emerging issue with respect to its apparent linkage to Parkinson’s disease. There was speculation that this sort of occupationally-specific exposure-linked health condition may well work its way into presumptive clauses in the near future, in part because of pressure elsewhere on medical costs.

Medical costs came up again in a discussion of the required switch in the US from the medical coding system known as ICD-9 to ICD-10. The change is mandated now for October 1, 2013 having been pushed back several times. The reporting has implications for workers’ compensation systems. There is no general equivalent matching that can be applied to ‘crosswalk’ old codes to new ones. The example used suggested that the code for the amputation of a finger go from one code to more than twenty.

Finally, we got a preview of data to be released in the Oregon Department of Consumer and Business Services' Workers’ Compensation Rate Ranking Survey. This survey is completed every couple of years. It lists a series of classifications that are the most costly from a workers’ compensation perspective in Oregon. It then applies the rates from other states to that set of classifications and payrolls from Oregon. The result is what the average rate would be in Oregon if Oregon had the other states’ rates. The study should be released in the coming weeks and will likely receive some media attention.

That’s a small portion of what was covered. In the coming weeks, I will have more details on some of these issues.

How many occupational health and safety inspectors should there be in a jurisdiction?

2010-09-14T08:20:00.000-07:00

Asking how many OH&S inspectors are needed is one of those tough questions I get time and time again. My answer is always the same: it depends. Every jurisdiction has to look at its own mandate, legislation, industry mix and population. A jurisdiction that is geographically small (or densely populated) will likely need fewer inspectors than a jurisdiction covering a large, sparsely populated geographic area. A jurisdiction with a high rate of serious injury may require more inspectors than one with a much lower rate of serious injury.

The International Labour Organization ( ILO ) publishes a recommendation regarding the ratio of inspectors to population. In a recent report, it made this comment:

Article 10 of Convention No. 81 calls for a “sufficient number” of inspectors to do the work required. As each country assigns different priorities of enforcement to its inspectors, there is no official definition for a “sufficient” number of inspectors. Amongst the factors that need to be taken into account are the number and size of establishments and the total size of the workforce. No single measure is sufficient but in many countries the available data sources are weak. The number of inspectors per worker is currently the only internationally comparable indicator available. In its policy and technical advisory services, the ILO has taken as reasonable benchmarks that the number of labour inspectors in relation to workers should approach: 1/10,000 in industrial market economies; 1/15,000 in industrializing economies; 1/20,000 in transition economies; and 1/40,000 in less developed countries

Strategies and practice for labour inspection GB.297/ESP/3 297th Session Geneva, November 2006

The ILO published data posted below shows that many jurisdictions fail to come close to these ILO recommended levels:

[caption id="attachment_142" align="alignnone" width="300" caption="ILO Ratio of Active Population to Inspector"][/caption]

The ratio of 1 inspector for every 10,000 active population (employment, or employed labour force) for industrialized jurisdictions like Canada, the US and Australia is just a guideline. Australia and New Zealand publish ratios for their respective jurisdictions. Data in Canada and the US are harder to come by. Where data exist, it is often difficult to verify what is included and excluded from each component of the ratio.

For WorkSafeBC, I use the 2009 count of field inspectors and investigation officers to ‘employment’ for December 2009 as published by BC Stats. This is imperfect for many reasons. This would include among workers those working in mining and communications (outside WorkSafeBC’s occupational safety and health mandate but within the workers' compensation mandate); the calculations also exclude Mines inspectors and Labour Standards inspectors (inspectors that might be included in some calculations). I suspect every jurisdiction would face similar challenges in preparing their ratios.

Keeping these caveats mind, I have gathered some of Inspector-to-Worker Ratios below:

California 1 : 69,613 (a)
Washington State   1 : 32,141 (b)
Oregon 1 : 22,239 (c)
Queensland, Australia 1 : 12,000 (d)
New Zealand  1 : 12,000 (d)
New South Wales, Australia 1 : 10,000 (d)
Victoria, Australia  1 : 9,000 (d)
British Columbia  1 : 9,100 (e)

Based on the range of jurisdictions in this short list, BC and the Australian jurisdictions have ratios nearest the ILO recommendation.

I have noted the sources for each of the ratios posted below. If you have a better or more recent source, or another similar ratio from an additional jurisdiction, please feel free to post a comment.

(a) California Department of Industrial Relations, Division of Occupational Safety and Health (DOSH), September 2, 2010

(b) Washington Department of Labour and Industries, September 2, 2010

(c) Oregon Department of Consumer and Business Services, Occupational Safety and Health Agency (OR-OSHA)

(d) Calculated from data in Indicator 14 for year 2007/8 Comparative Performance Monitoring Report, 11th Edition, Dec 2009

(e) Calculated from 2009 data on actual number of officers (249) and covered employed labour force as reported by BC Stats December 2009 (2.266 million)

Demographic impacts on workers' compensation

2010-09-13T05:30:00.000-07:00

Earlier this week I had an opportunity to speak about demographics to a Lunch n’ Learn audience at the Richmond offices of WorkSafeBC. This is a broad topic with implications for all of us: our families, our economies, and the world of workers’ compensation. There are global trends but the impacts are local –some are even personal—and cannot be ignored.

All of us are getting older individually—that’s obvious. What makes this time in our history so interesting is how the various age categories are distributed. One writer noted that more than half the people who have ever lived beyond the age of 65 are alive today. In developed countries, 70 million people will retire in the next 25 years…and be replaced by just 5 million young people entering the labour force.

So, what are the local impacts? Glancing at our Statistics book for 2009 provides some interesting facts:

· The average injured worker was over 40 years of age—a new record.

· More than 34% of claims first paid last year went to female claimants—another record.

· The percentage of claims first paid to workers under 25 fell to just 14% of our total volume and represented just 10% of our serious injury claims;

· Nearly 15% of claims first paid were to workers over the age of 55 and they account for 17% of our serious injury claims.

Graphing the distribution of time-loss work injury claims by age in BC, we can see a clear shift over the last twenty odd years. This shift is not just a function of changes in the provincial population profile.

Clearly, injuries to younger workers have declined. We have made gains in making workplaces safer for younger workers, technology has made jobs safer, our Regulation now requires specific safety orientation to new workers—all those initiatives have contributed to the decline in injuries in younger age categories. The age group 45-49 now has the highest number of claims. This increase in injuries to older workers is not a temporary phenomenon; we are likely to see more injuries to some older workers (and some very old workers) in the coming years.

This shift will continue to put upward pressure on duration. Older workers take longer to recover and often have pre-existing co-morbid conditions that may make recovery more complex. The risk of fatal injury actually increases with age.

None of this is really ‘news’. The predictions have been out there for years. The human body has not changed much with respect to its time to recover following injury. It stands to reason that a workforce with older workers getting injured will tend to have overall longer recoveries.

What are we to do in the face of these demographic trends? The fundamentals are the same:

· prevent injuries,

· rapid first aid when injuries occur,

· accurate diagnosis,

· effective and timely treatment and rehabilitation,

· consistent connection between the worker and the employer,

· timely safe and durable return to work.

The fundamentals, however, need to be responsive to the realities of the population of injured workers. Strategies tailored to young workers have been effective; a similar approach to reach older workers and women will hopefully have similar positive results.

What's behind the headlines about 'Fewer Worker Fatalities'?

2010-08-23T05:45:00.000-07:00

There have been a lot of headlines lately about the lower number of injuries. One headline read “ U.S. Worker Fatalities fall 17% to record low” [Bloomberg August 19, 2010 ]. The improvement over past years is certainly welcomed but in the U.S. that still means 4340 work-related fatalities. The headline also misses the fact that construction spending in the US fell by 15% over the same period.

As an aside, it is important to remember that the U.S. counts work-related fatalities is very differently from the way WorkSafeBC and many other reporting agencies report similar statistics. The U.S. Bureau of Labor Statistics (BLS) has a system called the Census of Fatal Occupational Injuries (CFOI). Certain work-related fatalities are excluded from CFOI. For example, occupational diseases are excluded. Deaths due to work-related heart attack or stroke are considered occupational diseases and are excluded. Fatal work injuries to workers under 16 are also not included in this database. In contrast, all these categories of work-related fatalities are included in the WorkSafeBC index.

Another difference between the U.S. data and what we typically see in Canada is the number of homicides and suicides that occur at work. These are included in CFOI. Last year, homicides in the CFOI numbered 521 [80% due to shootings] while suicides accounted for 237 of the fatalities in this dataset.

Returning to the impact of the recession on workers’ compensation, it is true that injuries have declined both in absolute numbers and in rate. The decline in numbers is to be expected: if no one works, there can be no work-related injuries. The decline in injury rate is more complex and is part of a trend that has been going on for some time in most countries, states and provinces. NCCI in the U.S. notes that claim frequency continued to decrease in 2009: down 4 percent (cf. reductions of 3.4 percent in 2008 and 3 percent in 2007). According to NCCI’s research, recession was predicted to put additional downward pressure on frequency, because the work force still working during the recession gains in experience and is less prone to injury.

Many articles have noted the increase in ‘severity’ during the recession. Unlike WorkSafeBC that has a special definition for ‘Severe Injuries’ most jurisdictions simply use duration of disability as a measure of severity. The idea that a recession would extend recovery makes intuitive sense. In a robust economy, most workers return to their accident employment well before reaching maximal medical recovery. In a recession, there may be fewer employers clamoring for injured workers to return and workers are more likely to remain on claim until they are nearer to or reach a full recovery (or a point of maximal medical improvement), which is their entitlement under most workers’ compensation systems.

As we come out of this recession, most analysts are predicting a modest recovery rather than a rapid expansion. Given that scenario, one can expect that severity/duration will decline slowly and the number of injuries will increase. We can anticipate upward pressure on the provincial injury rate partly due to recoveries in higher risk sectors and partly due to the ‘churn’ as businesses deal with modest expansion (new hires) and an acceleration in the retirement rate due to the underlying demographic impact as older workers grow in numbers and are replaced as they retire.

Why is Ontario's WSIB phasing out its LMR program?

2010-08-06T06:48:00.000-07:00

A few weeks ago, Ontario’s WSIB announced a major change in direction for its Labour Market Re-entry (LMR) program [roughly equivalent to WorkSafeBC's Vocational Rehabilitation Services]. The change will phase out the use of external providers and create a new Work Reintegration Program inside the WSIB.

First a little background. Back in 1997, Ontario moved to a ‘self-reliance’ model; most employers were mandatorily required to accommodate an injured worker in a return to work with the accident employer. The legislation also imposed a duty on the worker to cooperate toward this end. For workers who could not return to their accident employer, the LMR program became the option. The LMR program was to be delivered in the community by external professionals so in 1998, the internal disability case management and vocational rehabilitation functions of the WSIB for cases that could not return to their accident employer were outsourced.

In 2009, WSIB contracted an outside consulting agency to conduct an audit of the LMR and other Return-to-Work (RTW) services. The report recommended changes to the program to make it more consistent with the leading practices of other jurisdictions (including WorkSafeBC). This report, stakeholder consultations and a value for money audit showed that the re-training programs were not having the desired effect. The lack of a link between re-training programs [employability] and effective labour market re-entry [employment] was identified as one root cause. The absence of direct WSIB involvement in LMR actually hindered return to work and the effectiveness of LMR programs.

The solution? WSIB will phase out its use of external providers and will establish an internal role for ‘Work Reintegration Professionals’ who will actively “provide injured workers with a sound assessment and, if needed, high-quality, credible training that will -- to the best of the WSIB’s ability -- equip them for return to work.” Clearly, the move is toward achieving better RTW outcomes and higher wage replacements for injured workers.

The new Work Reintegration Program is expected to be fully in place by the end of 2010. According to the WSIB,

The new Work Reintegration approach will support:

Increased simplicity of communication and co-ordination of services between WSIB and workers,

Increased clarity of accountability,

Greater assurance of workers getting the service they need, when they need it,

Increased consistency of services provided in similar circumstances, and

Improved management of expectations and a reasonable level of investment within clear cost parameters.

You can read background on all this on the WSIB website .

My inbox after vacation

2010-08-03T09:10:00.000-07:00

I’m back from a break and have been catching up on developments in the world of workers’ compensation. Here are a few highlights from the my inbox over the last few weeks:
Washington State’s Secretary of State has certified Initiative 1082 that would open the workers’ compensation insurance market in that state to private insurance. The Initiative would also eliminate the portion of the premium paid by workers (a feature that may have attracted some workers to sign on to the petition). While 18% of a sample of the signatures in support of the initiative being placed on the ballot were ruled inadmissible, the required minimum of valid signatures was achieved so the provision will be on the ballot in November.

Arizona’s governor signed into law a provision that will take the Arizona State Compensation Fund from a public competitive state fund to a private entity. It currently has about a third of the market in that state. The move will allow the new entity to expand operations into other states.

Alberta’s Employment Minister, Thomas Lukaszuk, announced his department will post safety records of all companies in Alberta. What exactly will be posted has not been revealed but speculation in the media suggests workers’ compensation lost-time claim data (presumably counts and dollars) will be part of what is published. The move is intended to improve safety for workers in that province. Press reports attribute the following statement to the Minister:

"Today is a new day for occupational health and safety in the province of Alberta. This is the day when status quo is no longer acceptable. The hammer is coming down on those who persistently fail to comply with safety laws.”

Tennessee proposed a law that would require all construction service providers to be included in the scope of coverage unless specifically exempted—a procedure that is open to certain sole proprietors and others but with a catch: the firm must be registered and the exemption must be applied for (subject to fees) before an exemption card good for two years is issued.

President Obama has taken aim at the safety and return to work performance of federal agencies and executive departments. Under the acronym POWER (Protecting Our Workers and Ensuring Reemployment) departments are expected by

• Reducing total injury and illness case rates
• Reducing lost-time injuries
• Analyzing lost-time injury and illness data
• Increasing the timely filing of workers’ comp claims
• Increasing the timely filing of wage-loss claims
• Reducing lost production day rates
• Speeding return-to-work in cases of serious injury or illness

Vermont has increased the penalties for firms who are required to register and carry workers’ compensation coverage but fail to do so. Such firms will now be required to close immediately and a fine of $250 per day issued until they are in compliance.

I'm always interested in unique developments in workers' compensation and prevention. Feel free to send any you come across to me. As always, if you have any comments or insights, leave a post and add to the blog.

What influences will drive WC fund investments?

2010-07-05T09:44:00.000-07:00

The AWCBC Congress was held last week in Halifax. This event is held every two years and brings together delegates from all the Canadian workers’ compensation boards and commissions. Are such gatherings worth the cost and effort? In this case, the program content certainly made this a good investment for those who could attend. There were many great sessions presented by many experts but the highlight for me was the first address.

The keynote speaker, Jeff Rubin, provided an unscripted, succinct, insightful, provocative examination of the trends that triggered the recent world recession and will undoubtedly impact us in the years to come. Since workers’ compensation systems in many jurisdictions manage large investment funds to pay benefits to workers injured in the past, his insight was extremely important. He correctly predicted the run up in oil prices in the last decade and convincingly links that price climb to the financial turmoil that followed.

Where are we heading? Rubin believes we are at or near peak oil so the world consumption of oil will shift. North America will use less; China and India will use more… much more. You and I will learn to love mass transit, cycling and living in or closer to home. The Hundred Mile Diet will become more fashionable out of simple, practical economics: the cost of fertilizer and transportation will make bringing food from farther away more expensive. As oil hits $150 a barrel, papayas from Mexico will be too expensive for much of the Canadian market. He notes that as the price of oil ford to $100 a barrel, the cost of making steel will make domestic production once again competitive with anything China can deliver to the North American market.

What does the recent BP gulf disaster mean? Rubin acknowledges the devastation on the people and the environment. Ultimately, BP will pay the price and that may mean the end of BP. Fundamentally, however, Rubin thinks the markets—not regulators—that will make deep-water oil an uneconomic risk. Will anyone who buys BP’s deep water assets be able to afford the insurance for another disaster. In a way, the BP fiasco has pushed a lot of ‘reserves’ effectively out of reach.

As oil increases in price, the Canadian dollar will rise. There will be ups and downs but the general direction for both appears to be upward.

If what Rubin has to say is true, the world we live in is indeed going to get a lot smaller... and the implications for investments, employment and labour are huge. Add to this the demographic changes and the future will be very different than our past.

Demographics and Maritime Safety

2010-06-29T06:48:00.000-07:00

Last week I was in New Orleans and the National Maritime Safety Association (NMSA) conference. My role was as a speaker on demographic effects and this gave me an opportunity to look at some of the demographic changes that are impacting the industry in the US and beyond. Demographics is a term that just means population characteristics (gender, age, occupation…). The association is interested in that range of activities that are involved in and about the shipping, terminal services, stevedoring and related businesses.

The population of dockworkers and drivers working from terminal operations in the US has some interesting characteristics. As a group, according to one California study, they have a heart disease death rate that is higher than the rest of the population—49% higher for drivers and 32% higher for dockworkers.

In the UK, a recent study listed the fatality rates of ‘dockers and stevedores’ at 28 per 100,000. That would make this cluster of occupations the second most deadly in the UK.

A report out of New Zealand noted that the current average age of ‘Able Seamen’ is 54 years. It also noted that 72% of this group has 30 years of work experience at sea, and 17% with more than 40 years’ experience at sea. The demographic issues are pretty clear: Who will replace these workers as they age and leave the industry?

An Australian report noted that there is a skill shortage for occupations related to their ports. It warned of a drastic depletion of skills due to the ageing workforce; moreover, the population of young people who would be available to fill those jobs is being offered many other alternative career paths.

The bottom line for this industry (and many others) is that there are going to be fewer young workers and many more older workers. Older workers may well stay beyond the ages of retirement in the past to fill the demand. It also means that many older workers will be in specific jobs they might not otherwise have performed in the past. As one attendee at the event noted, during the recession, many of the first workers to be laid off were the younger ones. This meant that many older workers had to do jobs that they had not done in years and jobs that had changed due to technology. As we know, new workers (even if they are older workers) in new jobs are generally at higher risk of work-related injury.

Two presentations at the event were of particular interest. The first was from a firm called Flight Level Solutions. The founder and leader of this group was a military fighter pilot and the team he works with includes an astronaut. They specialize in Crew Resource Management, a training approach that is origins in flight operations but is now being applied to diverse areas such as healthcare, public safety and manufacturing. The basic premise from a prevention perspective is that “Safety is a by-product of Standardized Execution”. The parallels to Six Sigma, Lean and TQM are obvious but the emphasis on cognitive and interpersonal skills is substantially higher in CRM. In the wake of the PB disaster, this approach may offer another avenue toward safety.

Finally, I was really impressed with the work being done by Louisiana Immersive Technologies Enterprises for the Louisiana Department of Transportation. The technology demonstrated was a 3d interactive environment in which learners had to correctly position flag persons around a curve using a typical gaming controller. I subsequently found a brief article on the net. The speaker identified a couple of differences among learner groups. Learners who were gamers (mostly younger but not exclusively) immediately ‘got it’ and could apply what they had learned in lectures to this virtual world simulation. Others took a while to get the hang of it. With the gaming industry now exceeding the revenues of the film industry, the population of those who know how to game and operate in these immersive environments is likely to grow. There may be many more applications for this sort of learning in the future.

So demographics and maritime safety are linked both in the impact that demographic changes are going to have on the industry and on the technologies and training that will be needed to reach/teach/enable workers in the next couple of decades.

Will Washington state have the next Workers’ Comp system to allow competition?

2010-06-18T01:30:00.000-07:00

In Washington State, the Department of Labor and Industries (LNI), is the publicly run workers’ compensation insurer and occupational safety and health authority for the state. It is one of only four remaining ‘exclusive’ state fund workers’ compensation insurers in the US. Exclusive state funds are the closest cousins of Canadian workers’ compensation boards and commissions. If the current campaign to get an initiative on the ballot, Washington’s LNI as it is called, will lose its exclusive insurer status and other insurers will be permitted to enter the market and compete for the sale of workers’ compensation insurance.

Citizen-based initiatives are relatively rare in Canada. In BC we have the example of a campaign to get a referendum in front of the electorate regarding the Harmonized Sales Tax. Initiatives are more common in the US. In Washington state, to take an initiative to the people ( that is, to get a proposal on the ballot for the next election), an initiative proposal must be filed with the state and then, within prescribed time frames and get endorsements from a specified number of registered voters. This year, the threshold is 241,153 signatures by July 2, 2010.

According to the information filed with the state, I-1082 has the following purpose:

This measure would permit certification of private insurers as industrial insurance insurers, and authorize employers to purchase state-mandated industrial insurance coverage through an “industrial insurance insurer” beginning July 1, 2012. It would establish a joint legislative task force to propose legislation conforming current statutes to this measure’s provisions, and would direct the legislature to enact such supplemental conforming legislation as necessary by March 1, 2012. It would also eliminate the worker-paid share of medical-benefit premiums.

The full text of the initiative is available at the following link:

http://www.sos.wa.gov/elections/initiatives/text/i1082.pdf

Proponents of the initiative have a website www.safeourjobswa.com and opposition groups to the initiative have posted their arguments on a variety of websites and blogs including several union sites such as http://ibew191.com/node/443 and http://www.wslc.org/reports/2010/May/18.htm#Tuesday .

If the intent of the initiative sounds familiar, it should; this initiative has a similar intent to the Bill debated in the Ontario legislature late last year. As you will recall, that Bill sought to allow private insurers to enter the Ontario market and compete with WSIB for the sale of workers’ compensation insurance to employers in that market. (See my earlier post). In Canada, the US and Australia, when dissatisfaction with an exclusive state fund rises, so do the calls for privatization and competition despite strong evidence that private or competitive models will be no less costly or efficient.

Direct comparisons between Canadian Boards and individual states are difficult but from a number of research studies and analysis we can say that over the long run, the Canadian model delivers higher benefits to workers and lower costs to employers than the typical US system. We also know directly from research carried out by the late Terry Thomason and John F. Burton, that exclusive state funds (which included the BC and Ontario boards) consistently provided lower costs to employers over a two decade time frame than either purely private markets or markets where there was competition permitted with a state fund.

It remains to be seen if the proponents of I-1082 will achieve the required number of signatures. If they do, the initiative will appear on the November 2010 ballot. Whatever happens in Washington State (or Ontario), the best defense any exclusive system can mount against such initiatives is to provide incredibly customer-focused, efficient service to all our stakeholders and to work with them to reduce the human and financial costs of work-related injury, illness and disease.

Does the basis of calculating WC benefits influence reporting of claims?

2010-06-08T03:24:00.000-07:00

If you miss time from work due to a temporary total disability, the amount you receive from an insurer will determine if you can put bread on the table and pay the rent. The quantum of compensation varies with the type of insurance.

Although we do not think of ‘sick leave’ as a form of insurance, in many ways it is like an insurance plan. Sick leave credits or allocations are often earned and may or may not have any residual value upon termination or retirement. In most cases, sick leave provides 100% of wages and is taxable. Sick leave plans are generally free of ‘deductibles’.

For those without sick leave plans as described above, Employment Insurance generally offers some sick leave benefits. In Canada, these amount to 55% of gross up to an insured maximum and all benefits are taxable. There is generally a two week waiting period before benefits may be paid under an EI claim.

Workers’ compensation is a form of insurance. The benefit rate for short term disability varies by jurisdiction. WorkSafeBC provides 90% of net earnings (where net equals gross earnings minus appropriate [mostly mandatory] deductions for employment insurance premiums and Canada Pension Plan contributions as well as applicable federal and provincial income tax) and compensation is tax free. BC does not have any waiting periods so benefits are payable from the day following the day of injury.

Not all workers’ compensation systems compensate at the same level. Most US states set the basis for compensation at 66 2/3% of gross earnings. A sampling of other jurisdictions reveal a range of alternatives—generally higher than the 67%:
• Maine uses 80% of worker’s ‘spendable’ earnings (or net wage after tax)
• Connecticut and Rhode Island uses 75% of worker’s spendable earnings
• Texas uses 70% of the worker’s pre-injury weekly in most cases
• Washington State’s compensation varies by marital status and number of dependents so the range is from 60% for a single to 75% (spouse adds 5% and each dependent 2%).

Most states have a waiting period of 3 to 7 days although most systems offer a ‘retroactive period’ such that the worker will be reimbursed for the waiting period if the wage-loss extends beyond (typically) 14 to 28 days.

Canadian jurisdictions generally compensate temporary total benefits at a higher level than their US counterparts. WorkSafeBC’s 90% compares well with other Canadian jurisdictions:

• Ontario, Prince Edward Island and New Brunswick use 85% of net
• Nova Scotia uses 75% of net for the first 26 weeks and 85% after that

Waiting periods are not common in Canada but do exist in New Brunswick (3 days), Nova Scotia (2 days) and PEI (3/5ths of weekly wage loss benefits to the worker.

While workers have an incentive to claim workers’ compensation benefits over EI for work-related claims, the same may not be true for work-related injuries.

Beyond the fact that waiting periods and departures from 100% of net earnings shift some of the costs of injury to injured workers, the level of compensation may influence reported injury rates. Take the case of a worker who suffers an injury that will result in two weeks away from work and a loss of $1000 net earnings (2 weeks at $500 per week). If the worker has access to a sick leave plan, the worker will likely receive 100% of usual net earnings or $1000. If the worker claims workers’ compensation benefits in a jurisdiction with a 3 day waiting period and an 85% of net benefit rate, the benefit will be $595. In a jurisdiction with no waiting period and a 90% of net benefit rate, the benefit will be $900. If the worker has the option of claiming either sick leave or a workers’ compensation benefit, it is clear that the sick leave route will minimize the burden of the injury the worker must bear. The propensity to not claim under workers’ compensation will increase (at least for shorter duration claims) the greater the financial cost the worker must bear.

This is another example where reported injury rates must be interpreted in context. As a general rule, one would expect jurisdictions with waiting periods and lower replacement of net earnings levels to experience lower injury rates for at least shorter duration injuries.

What's new in Canadian Research on Work and Health?

2010-06-01T06:05:00.000-07:00

I spent part of last week at the Canadian Association for Research on Work and Health (CARWH) conference in Toronto. The conference theme was Worker Health in a Changing World and participants included about 300 researchers from across Canada with some from the US and even Australia.

So, what was preoccupying the researchers at this event? There were so many threads, it is hard to pull them all together but here is a short list of topics that might give you a hint of the range discussed in sessions or presented in poster sessions: asbestos, shiftwork/nightwork, vulnerable workers and those in precarious employment, stress, the heath of truck drivers, pesticides and cancer, effectiveness of OHS training and education, trends from Ontario's high risk firm intervention progam.

As with any multi-stream event, there is no way any one person can see or hear all presentations so it is a bit unfair to highlight some topics over others. That said, I was really impressed by a couple of presentations that I did attend and think you will find them of interest as well.

For those of you who work with larger employers, there was a great example from Fraser Health. Shannon Atkins demonstrated how an internal call centre approach reduced the time for filing employer reports. From the paper abstract, "Results to date are impressive. Form 7 submission timeline reduced from an average of 16.9 days to 1.72 days, with a mode of 0.04 days. Claim duration has been reduced from 49.2 days pre-call centre to 36.5 days."

Another fascinating presentation was "Long-duration claims – what is driving increases in duration and locked-in claims in Ontario?". Sheila Hogg-Johnson's analysis showed that both duration and locked-in claims increase coincidentally with January 1998's Bill 99 legislative and policy change. Now work is going in to examining exactly why.

Several speakers discussed qualitative research examining topics like Joan Eakin's "The stigmatization of injured workers: The construction of "unworthiness" in the compensation process". The care and concern for workers generally was reflected in every presentation.

Cameron Mustard's work on comparing BC and Ontario long-term care injury rates and durations was preliminary but demonstrated the great power in using large data sets from different jurisdictions to ‘tease out’ differences (and that may lead to new approaches for fewer injuries and shorter duration).

One of the most insightful comments from the two days was contained in a presentation by Genevieve Baril-Gingras from Laval. She and a dozen other colleagues reviewed the occupational safety and health law in Quebec by examining its provisions with those of other jurisdictions elsewhere in Canada and the world. Their findings resulted in a set of recommendations, each one backed by what they found from the science and experience elsewhere. And each recommendation was based on a proven provision in place in one or more of the other jurisdictions examined. Clearly, there will be lessons for other OHS and workers' compensation agencies in this paper.

Beyond the findings and the recommendations, her presentation contained one line that really impressed me. She said: "Academic freedom = Responsibility". Researchers need the freedom to gow where the research leads them, and if it leads them to conclusions that are uncomfortable or inconvenient, researchers still have a responsibility: to tell it like it is.

Just how research will be used by legislators and policy makers will depend on many factors. The likelihood of making the best public policy decisions, however, depends on accurate, well researched information. I'm glad there are people out there who take that responsibility in the study of work and health so seriously.

To include or exclude Professional Sports Competitors from Workers' Compensation Coverage

2010-05-25T04:24:00.000-07:00

Who should be covered by workers’ compensation? In the beginning, coverage was limited to primarily industrial workers but most systems have expanded who is included within the scope of coverage. In some cases, inclusions are accomplished by specifically identifying the industries (or occupations) to be covered in legislation. In others, as in British Columbia, the legislation simply defines a principle (inclusion) and the specifics of any exemptions (exclusions) are defined by policy decision.

Of jurisdictions with universal coverage, the rationale for inclusion is pretty straight forward. From a prevention perspective, inclusion of all occupations provides an opportunity to strengthen the barriers, safeguards and defenses against personal injury and disease related to earning a living. By engineering, substitution and administrative controls, the risks that would otherwise harm the worker can be minimized if not entirely eliminated... and the cost of workers' compensation premiums may provide an incentive to invest in these protections (or an added penalty for failing to).

Further, inclusion means all workers have equivalent protections. From a workers’ compensation perspective, insurance for (hopefully) rare events is provided and crystallizes the likely risk of a rare large financial claim or suit to the employer; the premium and experience rating for a particular employer with workers in and about an industry serves as an added and (more or less) constant pressure to invest in prevention. A further rationale is that mandatory inclusion prevents the costs of injury (and necessary healthcare) from being externalized to the public purse.

For jurisdictions with exclusions from universal coverage, the rationale may be more complex. One rationale may be that the risks are very small and the costs of any actual injury or disease arising from the work very low so the benefits of insurance are negligible. Other jurisdictions suggest that industries with ‘equivalent’ coverage may be exempted from the provision. Sometimes, exclusion from some aspects of the workers’ compensation plan can be achieved by ‘carve outs’ and to a certain extent, self insurance with self administration, although this avenue is usually allowed only if the firm is large enough, financially stable enough, and ‘safe’ enough in the eyes of the jurisdictional regulator. It may be necessary to include all firms under prevention standards but the workers’ compensation coverage by this logic would be optional. On one hand, this should increase the firms motivation to protect workers since they will bear the costs of a suite or suitable settlement. Unfortunately, this does not protect the taxpayer (in Canada at least) from the potential costs associated with health care and those who may not receive a speedy settlement (or never get the chance). Exempting an industry or occupation, therefore, should intentionally consider these consequences.

Professional sports competitors in hockey, football, winter sports like skiing are obviously poor candidates for inclusion. The inherent risks and latent defects in the safeguards, barriers and defenses that would otherwise protect them from harm are numerous. It is hard to think of regulating maximal exertion on razor-sharp blades while carrying long sticks and making body checks safe without taking these essential elements out of professional hockey. And on the insurance front, who would you pool the risk of mixed martial arts competitors with? In these sports, the economic model of what you can get ‘workers’ to do, is really an economic expected value one. The pay and contracted benefits are going to have to convince the sports competitor (and his agent) that the residual risks of competing are being properly anticipated and compensated while the ownership (and those setting the rules) are going to have to make assurances sound enough to likely fend off potential suits.

Is there a case for their inclusion of sports competitors? Aside from the inherent externalization of necessary health care costs to the public purse (or a violation of the Canada Health Act principles if the sports team ownership pays for those services) and the principle of universality on its own, I don’t think so. That said, I don’t see any rationale for excluding coverage for the team coach, trainers, managers and other staff. Their work and risks are not dissimilar from recreation facility staff, fitness instructors and equipment managers in many other sectors (schools, universities, private gyms, community recreation facilities).

I would be interested in your views.

Are all reported Injury Rates (IRs) equivalent?

2010-05-13T02:31:00.000-07:00

I look at a lot of reports and see a wide variation in the reported injury rates among what should be similar jurisdictions. What accounts for these differences? In some cases, there are wide differences in the ‘mix’ of industries covered. You can expect a jurisdiction with a large service sector and small primary resources and construction sectors to have a lower injury rate than one dominated by construction, mining and forestry. That aside, variability can also have a lot to do with definitions.

The AWCBC reports an Injury Frequency statistic based on the following definition:

Number of new lost-time claims for assessable employers per 100 workers of assessable employers

Note the definition depends on what is counted in the numerator (lost-time claims) and what is used as the denominator (workers of assessable employers). AWCBC also defines Lost-time Claims in this way:

A lost-time claim is a claim where an employee is compensated for a loss of wages following a work-related injury (or exposure to noxious substance), or receives compensation for a permanent disability with or without any time lost in his or her employment (for example, if an employee is compensated for a loss of hearing resulting from excessive noise in the work place).

So, another source of variability is in what is reported as compensated. If a jurisdiction has a waiting period or actively promotes ‘stay at work’ programs, claims involving loss of wages will be lower in that jurisdiction than in a similar jurisdiction without a waiting period or significant stay-at-work program.

In a previous blog, I noted the difference in reporting requirements. In addition to those issues, the source of the statistic also needs to be considered. In the US and Europe, most published data is based on Occupational Safety and Health data. In the US, OSHA has specific definitions for what is reportable and these ultimately have an impact on the reported IR. Further, within the reportable cases, there is a distinction between ‘days away from work’ cases and those where ‘alternate duties’ are assigned. While most workers have workers’ compensation coverage in the US, most published IRs are not based on claims.

At WorkSafeBC we report a Provincial Injury Rate in accordance with the AWCBC definition. For BC, where 93% of the employed labour force is covered, this is a pretty reasonable estimate of the provincial IR. Note, however, that it reflects assessable employers only. It does not include, for example, the injuries that occur within the Provincial Government public service as the Provincial Government is not an assessable employer. In provinces with lower covered populations and higher proportions of non-assessed employers, what is reflected in the IR may be far less representative of the provincial injury rate.

Finally, the IR that is reported in some other jurisdictions excludes from the numerator claims (or work absences) of very short duration. WorkSafeBC’s Injury Rate is an IR0 (claims involving at least some wage loss) and the US generally uses IR0 (reportable cases involving days of work absence) although some reports use IR3. In Australia, where one week of work absence is the threshold for a claim in most jurisdictions, their reported claim rates would be equivalent to IR5 or IR7 (depending on the basis for compensation being 5 or 7 days).

So, when you are looking at injury rates in other jurisdictions, dig a little deeper and understand the inherent differences before drawing any conclusions. For the record, WorkSafeBC’s Injury Rates are as follows:

IR0: 2.34, IR3: 1.75, IR5: 1.50, IR7: 1.35 (In the 2009 Annual Report, the Provincial Injury Rate [IR0] is reported as 2.37, the best estimate available at the time of publication).

The Core of COR (Certificates of Recognition)

2010-04-24T07:36:00.000-07:00

The Certificate of Recognition (COR)Program is a relatively new feature of some workers’ compensation / prevention systems. Designed primarily as an incentive for employers to implement and maintain a robust safety and health management system that meets a set of criteria established for the employer’s particular industry, these programs are generally voluntary, time-limited before having to ‘renew’, and involve external audits.

COR programs are offered by several jurisdictions in Canada but I can find little in the way of formal published research on the benefits and costs associated with COR. To complicate matters, there is no ‘standard’ for COR certifications (although some jurisdictions are recognizing CORs from other provinces).

A COR program is usually offered by the agency responsible for prevention and may carry benefits for the firm in terms of lower workers’ compensation premiums. In Alberta, COR is offered by Alberta Employment and Immigration. Firms must undergo an audit by a Certifying partner. Qualifying firms are expected to achieve a pass on every element in the audit and an overall score of 80% or better. The elements examined relate to the Health and Safety Management System.

The Yukon and Nova Scotia have introduced programs under the name COR. Many larger firms use COR as a pre-requisite for subcontractors and providers

In British Columbia, a COR program is offered by WorkSafeBC. Certifying Partners offer audits but the goal goes beyond meeting required OH&S primary prevention standards. The COR program in BC recognizes and rewards employers who go beyond the legal requirements of the Workers Compensation Act and the Occupational Health and Safety Regulation by taking a best practices approach to implementing health and safety management systems. Firms who also meet standards for return-to-work (RTW)/Disability Management programs can obtain an additional rebate. Achieving COR status for both area can net the employer a 15% rebate on premiums.

In WorkSafeBC’s case, the benefits to the employers who qualify for COR go beyond the rebate. Theoretically, these employers should have fewer defects in their safety programs, fewer violations of safe work procedures, and lower costs associated with work-related injuries. Workers in such firms theoretically benefit from safer workplaces, strong adherence to safe work procedures by co-workers and other persons in the workplace, and improved prospects for a safe and durable return to work. The COR certification may also give qualifying firms an advantage in competitive bid processes.

As I said, there is little in the way of formal peer-reviewed research on the benefits of any COR system currently in place. One administrative review was recently conducted by the Auditor General of Alberta. The AG found:

Half of those employers that persistently fail to comply with the OHS Act also continue to hold a valid Certificate of Recognition (COR), 4 and continue to have elevated injury rates among their workers. In short, although these employers do not comply with OHS orders, and their workers are much more likely to get injured on the job, these employers continue to receive Partners in Injury Reduction financial rebates and use their COR to bid on contracts with major companies in such industries as construction, and oil and gas.

As more COR programs are established and have had time to operate for several years, more independent formal research will tell us if these programs are yielding their planned benefits for workers and employers.

Does leadership really matter?

2010-04-12T20:41:00.000-07:00

Does leadership really matter? I’ve always believed the commitment of an organization’s leadership to safety and health makes a difference. The more I look at the impact effective leadership has on safety and health in different organizations, the more certain I am of the answer to this question.

I think of leadership from a functional perspective. In this context, effective leadership is about achieving the leader’s desired outcomes through the actions of others because others share the leader’s vision. Autocratic, dictatorial leaders can and do achieve outcomes through others, but not because their followers share any common vision or commitment to the leader’s vision. Charismatic leaders can often achieve their desired results, too, but followers of such leaders tend to act out of loyalty or commitment to the charismatic leader rather than the ideal or outcome the leader desires.

Effective leadership in the health and safety context depends on something other than the charisma or dictates of the organizational leader. It depends on a real commitment—the understanding, internalization and action—of those at the top of the organization that is shared down to the operational front line. It depends on communication—the tangible and consistent message that safety and health priorities are the priorities of the leadership. It depends on vision—a clear articulation of the desired state.

I recently heard David Eherts- VP Chief Safety Officer Sikorsky Aircraft and Joe Grabinsky- Chief Union Environmental and Health Steward at Sikorsky speak about Sikorsky’s safety and health culture. Their corporate mission statement “We pioneer flight solutions that bring people home everywhere…every time” was put in context with their health and safety view. They described the culture on the shop floor as one where “we take care of each other”. They have “The Safety Dollar Program”, a safety and health reward program based on positive reinforcement and recognition for employees doing the right things when it comes to working safely and taking care of each other. The rewards are cash credits to items from a designated web store where the credits can be exchanged for safety-related items for the home, car, kids, and even pets. This culture has lead Sikorsky to reduce its lost time injury rate from 4.0 [per 100 FTEs] in 2004 to just 0.9 in 2010.

That talk was delivered at a two day event at Maersk North America’s President’s Safety Council meeting in Charlotte, NC. Maersk shares the view that safety and health culture is critically important to corporate success—including profitability. This was their ninth annual event that focuses Maersk leadership( the presidents of their group of companies, operational leaders, and some front line managers) on nothing but health, safety and the environment. In front of their chair, Russ Bruner, and their colleagues each president spoke of their operations’ progress and listened to presentations from others like Sikorsky on how to take their HSE performance to the next level. Maersk’s “Drive to Zero” campaign has seen their OSHA reportable injury rate fall from 9.53 [per 200,000 hours of employment] in 2003 to just 1.64 in 2009, and their time loss injury rate drop from 8.0 to 0.38 over the same time frame. It was amazing to see the commitment to safety from the top management to management at the shop floor level at Maersk. In that room, there was a palpable excitement about HSE and a sincere belief that attaining a zero reportable injury rate was both achievable and in the best interests of workers, shareholders and customers.

Firms like Sikorsky and Maersk demonstrate that leadership matters when it comes to health and safety. In Canada, a growing number of firms are putting health and safety at the top of their priority lists. The signatories to the CEO Health & Safety Leadership Charter are another group of employers who are giving life to these ideals.

“Leadership and learning are indispensable to each other” [from a speech John F. Kennedy was to deliver on the day he was assassinated]. If you know an organization that epitomizes safety and health leadership, share their success, post their story and help others to learn how leadership can make a difference.

Raising OSHA Penalties

2010-04-01T03:45:00.000-07:00

I was at a Health, Safety and Environment conference in North Carolina this week and some of the side discussions centered around what motivates employers to more complete compliance with OH&S regulations and standards. As I noted in my post February 4 post, some firms have a very strong safety culture but others –particularly those who should know better—factor the perceived cost of compliance against the perceived probability of non-compliance being detected times the estimated costs (dollars, reputation…) of the sanction. It appears DAVID MICHAELS, US Department of Labor Assistant Secretary for Occupational Safety and Health has been thinking about this, too.

In testimony before the US House of Representatives Subcommittee on Workforce Protections on March 16, 2010, Dr. Michaels supported legislation [the Protecting America’s Workers Act or PAWA] that would, among other things, significantly increase the cost of sanctions. He noted:

Safe jobs exist only when employers have adequate incentives to comply with OSHA’s requirements. Those incentives are affected, in turn, by both the magnitude and the likelihood of penalties. Swift, certain and meaningful penalties provide an important incentive to “do the right thing.” However, OSHA’s current penalties are not large enough to provide adequate incentives. Currently, serious violations — those that pose a substantial probability of death or serious physical harm to workers — are subject to a maximum civil penalty of only $7,000. Let me emphasize that — a violation that causes a “substantial probability of death — or serious physical harm” brings a maximum penalty of only $7,000. Willful and repeated violations carry a maximum penalty of only $70,000 and willful violations a minimum of $5,000.
Currently, the average OSHA penalty is only around $1,000. The median initial penalty proposed for all investigations in cases where a worker was killed conducted in FY 2007 was just $5,900.

He went on to compare these penalties with those in other areas and violations.

The current penalties do not provide an adequate deterrent. This is apparent when compared to penalties that other agencies are allowed to assess.For example, the Department of Agriculture is authorized to impose a fine of up to $130,000 on milk processors for willful violations of the Fluid Milk Promotion Act, which include refusal to pay fees and assessments to help advertise and research fluid milk products. The Federal Communications Commission can fine a TV or radio station up to $325,000 for indecent content. The Environmental Protection Agency can impose a penalty of $270,000 for violations of the Clean Air Act and a penalty of $1 million for attempting to tamper with a public water system. Yet, the maximum civil penalty OSHA may impose when a hard-working man or woman is killed on the job — even when the death is caused by a willful violation of an OSHA requirement — is $70,000.
In 2001 a tank full of sulphuric acid exploded at a Motiva refinery. A worker was killed and his body literally dissolved. The OSHA penalty was only $175,000. Yet, in the same incident, thousands of dead fish and crabs were discovered, allowing an EPA Clean Water Act violation amounting to $10 million — 50 times higher.

If you have a few minutes, you might want to review the full text of his testimony. I found the testimony compelling. It will be interesting to watch the development of the PAWA.

The not-so-exclusive remedy

2010-03-25T09:04:00.000-07:00

A recent Ohio Supreme Court decision prompted some thoughts about workers’ compensation as the ‘exclusive remedy’ for work-related injury, illness, disease and death.

In Canada and most of the US, we think of workers’ compensation as being the exclusive remedy, that is, compensation for work-related injury or disease is limited to the wage loss, permanent disability and medical compensation defined by the workers’ compensation law and policy in force in a particular jurisdiction. Injured workers (or their survivors in fatality cases) are not permitted to seek other remedies for the work-related losses; for example, a worker is prohibited by law (statute barred) from suing the accident employer or another worker. (Of course, if a third party is at fault, there may be a right of action that may be taken as an alternative to compensation or pursued by the workers’ compensation authority as a subrogated right). The Ohio case reminded me that some states allow for exceptions to the exclusive remedy rule.

In the Ohio case, legal precedent in that state and a change in the Ohio tort law five years ago defined an exception to the exclusivity of workers’ compensation. It allowed a worker to both collect workers’ compensation and pursue an action against an employer if, and only if, the worker could prove the employer acted with “deliberate intent” to harm. The statute reads (in part) as follows:

R.C. 2745.01, effective April 7, 2005,
(A) In an action brought against an employer by an employee, or by the dependent survivors of a deceased employee, for damages resulting from an intentional tort committed by the employer during the course of employment, the employer shall not be liable unless the plaintiff proves that the employer committed the tortious act with the intent to injure another or with the belief that the injury was substantially certain to occur.

(B) As used in this section, ‘substantially certain’ means that an employer acts with deliberate intent to cause an employee to suffer an injury, a disease, a condition, or death.

(C) Deliberate removal by an employer of an equipment safety guard or deliberate misrepresentation of a toxic or hazardous substance creates a rebuttable resumption that the removal or misrepresentation was committed with intent to injure another if an injury or an occupational disease or condition occurs as a direct result.

The section clearly puts a high test on what would be an intentional act intended to or substantially certain to injure a worker. The examples in paragraph C anchor the intent of the provision to very plausible but likely very rare situations. And the Ohio Supreme Court certainly confirms a very narrow access to the exception.

Similar exceptions to the exclusive remedy exist in some other states for cases of reckless or wanton disregard for the safety of the worker. According to Larson’s, Ohio, Louisiana, North Carolina, Connecticut, Oklahoma, New Jersey, South Dakota, and Texas—now employ a “substantially certain” standard.

In Australia, access to common law remedies still exists in most states (but not in SA or NT and limited access in Victoria and ComCare). In Queensland there is an unrestricted worker right to seek common law damages against an employer for breach of duty or negligence. One report says common law claims represent just four percent of all claims, but 40 percent of claim costs. That state has a discussion paper proposing a narrowing of access to common law by adopting a 10%-15% threshold in whole body impairment.

Social justice reasons are sometimes given for allowing exceptions to the exclusive remedy rule. Some see access to common law remedies for serious harm resulting from intentionally or substantially certain harm as a mechanism to deter such behaviors and improve worker safety. On the other hand, many view exceptions to the exclusive remedy as an erosion of the Historic Compromise.

In isolation, each of these arguments may have merit, however, I am of the view that you cannot look at any single feature of a system—including exceptions to the exclusive remedy rule-- in isolation. This is less a form of cultural relativism and more a position that accepts more than one arrangement of public policy features can achieve similar if not exactly equivalent outcomes.

I am certain others will have strong views for or against exceptions to the exclusive remedy rule so feel free to post them.

Is Asbestos-related Disease a Pandemic?

2010-03-08T12:13:00.000-08:00

Last week I attended a conference on Asbestos Surveillance and Compensation. On presentation by Dr. Leslie Stayner (Professor and Director of the Division of Epidemiology and Biostatistics at the School of Public Health, University of Illinois at Chicago) asked the provocative question, “Is there really a pandemic of Asbestos diseases?”

I suppose one way to answer this questions is to ask if Asbestos is causing the same sort of damage as other pandemics. Pandemic H1N1 influenza is a current and convenient comparator. The World Health Organization recently stated, “As of 28 February 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 16,455 deaths.” By comparison, Stayner pointed out that WHO estimates from 2006 placed the occupationally-related deaths from asbestos disease at approximately 90,000 per year:

43,000 Mesothelioma
39,000 Lung Cancer
7,000 Asbestosis

He points out that this estimate does not include other cancers such as Laryngeal and ovarian cancers that may be asbestos related.

The next way to evaluate his claim that asbestos disease is a pandemic is to see if it really is represented worldwide. Quoting from various research sources, professor Stayner showed the distribution of mesothelioma alone was covered much of the planet with the highest rates of disease in countries with the highest consumption of asbestos. While Australia had the greatest number of cases mesothelioma deaths per million per year, other countries such as Canada, the US and Great Britain were in similar territory. Countries from Asia, South America and Europe were also widely represented. Africa does not register highly in this analysis (but that may be changing).

So, on the face comparison with pandemic H1N1, asbestos-related disease has almost the same spread and actually a greater number of deaths.

Stayner’s point is that we need to think about asbestos-related disease as being an active disease of the present and not of the past. He notes that asbestos disease is on the rise in most of the world and that production and consumption of asbestos has remained relatively flat (although down in developed countries, increasing in the developing nations). He adds that we can expect the epidemic in the developed world to start to gradually decrease in 10 to 20 years; based on consumption, he expects to see increases in developing nations.

It is important to note that asbestos persists in our environment. The installed base of products with asbestos are going to be with us for a very long time.

As we saw with pandemic H1N1 influenza, once you attach the pandemic label, funds and resources as well as public attention may be brought to bear on prevention, treatment and control. Elimination of disease is the ultimate objective.

Stayner concluded his presentation with the following quote from the WHO 2006 Report on the Elimination of Asbestos-related diseases:

“The most efficient way to eliminate asbestos-related disease is to stop the use
of all types of asbestos.”

Perhaps he is right. Perhaps we should start thinking about asbestos-disease as a pandemic and bringing resources, education, and prevention efforts to eliminate asbestos-related disease.

How serious is a 'Serious Injury'?

2010-03-03T09:28:00.000-08:00

All work-related injuries, illnesses and diseases are serious. Period. I will go further and say that many ‘near misses’, exposures, and traumatic events that do not involve any physical harm to the worker are also very serious. If you believe this as I do, you are part of the way to understanding why it is important that such events be reported. You will also agree that the impact of certain work-related harms can be life changing or even life ending while others result in only minor interruption in work or life’s day to day activities. So how do workers’ compensation and prevention agencies decide which harms deserve the most attention?

In measuring the unacceptable, the most common way to differentiate this spectrum of harms is to focus only on those that result in time away from work. Lost-time injuries are the basis for most Injury Rate calculations. There are three major ‘threshold’ measures Injury Rate measures:

IR or IR0 includes all cases that result in any time lost from work beyond the day of injury
IR3 includes only cases that involve more than 3 days away from work
IR5 or IR7 based on cases that involve greater than one work week away from work

While WorkSafeBC reports the provincial injury rate as IR0, much of the world uses IR3 as the threshold. The US Bureau of Labor Statistics and OSHA have reporting systems and analysis based on this measure. The Workers’ Compensation Research Institute uses IR7 in most of its analysis.

It is important to note the source of any reports you might look at. While WorkSafeBC is both the workers’ compensation insurer and the primary prevention agency for the province, these roles are often split and the data collected can be very different. Australia reports Compensation Claims Frequency based on absences of greater than a week. This is not exactly the same as an IR7 but it is similar enough for most purposes.

Chile’s ACHS, the largest mutual workers’ compensation insurer, reports the distribution of injuries by number of days lost. Using the translated equivalents of “minor” (1-3 days), “serious” (4-10) days) and “very serious” (the balance usually displayed as separate lines 15 days to 24 days, those in the range of 25 to 50 days and those greater than 50 days).

Categorical measures are common in specific industries. The airline industry, for example, has a Serious Injury Rate (using ‘per 1,000 departures’ as the denominator) and defines Serious Injuries as follows:

Every injury that
(1) requires hospitalization for more than 48 hours, commencing within 7 days from the date the injury was received;
(2) results in a fracture of any bone (except simple fractures of fingers, toes, or nose)
(3) causes severe hemorrhages, nerve, muscle, or tendon damage;
(4) involves any internal organ; or
(5) involves second- or third-degree burns, or any burns affecting more than 5 percent of the body surface

The advantage of categorical definitions is that they can quickly focus attention for prevention.
A similar approach is used by WorkSafeBC in its Serious Injury Rate. I would classify this as a composite measure because the measure includes fatalities, long duration claims, high medical costs and other time-loss claims involving certain ICD-9 injury codes. This approach has the advantage of being clearly focused on those work-injury events that have had or could potentially have life altering or ending consequences.

Whatever the method, every system needs a basis to prioritize harms for the purpose of preventing them. Even though there is no universal standard, allocating resources in such a way as to reduce and eliminate harms is an essential element to any prevention strategy.

Is competition the answer for WC in Ohio?

2010-02-23T12:30:00.000-08:00

The workers’ compensation scene in Canada is dominated by provincial boards or commissions with exclusive authority to provide workers’ compensation insurance coverage to employers and benefits to workers. In the US, only four states have similar models: Ohio, Washington, Wyoming and North Dakota. Ohio is the largest and appears to be the latest to be looking at opening the market to competition. Back in November, the Ohio State Senate approved Resolution 118

“To create the Competitive Workers' Compensation Task Force to review the feasibility of allowing employers the option to obtain private insurance to insure their obligations under the workers' compensation system of Ohio.”

Is competition for the provision of workers’ compensation the answer? Comparative research suggests that competitive or open markets for workers’ compensation provision do not result in lower costs or better outcomes than exclusive state or provincial provision.

Comparisons between workers’ compensation systems is hard and much caution must be used in evaluating such comparisons. That said, I was interested in seeing the Institute for Work and Health’s (IWH) Issues Briefing document comparing the Canadian style workers’ compensation system with a jurisdiction dominated by competing workers’ compensation providers—California.

The IWH analysis summarizes its key messages this way:

The administrative costs of the workers’ compensation system in California, where benefits are provided mainly through private insurers, are much higher than in Canada, where workers’ compensation is provided mainly through a single public agency in each province.
Both workers and employers realize benefits from the public administration of the Canadian system compared with the competitive private insurance market for workers’ compensation in the state of California.

The IWH paper cites an earlier, comprehensive study that found a similar cost advantage in favour of monopoly provision of workers’ compensation insurance in BC and Ontario over states with competitive state funds and private markets. [Thomason T, Burton JF. The cost of worker’s compensation in Ontario and British Columbia. In: Gunderson M, Hyatt D (eds), Workers’ Compensation: foundations for reform. University of Toronto Press, Toronto. 2000]

Comparisons and benchmarking performance are hard to do and no comparison—or system—is perfect. Within the population of monopolistic systems, there are likely very good performers and very poor ones. The same can be said of private insurers and competitive state funds. Each underlying insurance model has its advantages and disadvantages. Competition or monopoly alone does not guarantee success.

Workers’ compensation is an important social insurance program that must always be guided by public policy objectives. How best to meet those public policy objectives should trump purely dogmatic considerations over structure.

The Ohio taskforce is due to report out by June 30. It will be interesting to see if the taskforce considers the issues and the evidence.

What is a ‘reportable’ injury?

2010-02-16T10:22:00.000-08:00

I was asked last week to compare injury rates from two jurisdictions. I had to explain that this is not easily done. Economic mix, demographics of the workforce, differences in benefit terms (waiting periods, employer deductibles) and other factors can impact such a comparison. One factor, in particular, came up that is often overlooked: injury reporting requirements.

Before a workers’ compensation or prevention organization can act on an injury, illness or incident, there must be a report to the organization. What is reportable will have a large impact on key statistical measures including time-loss injury rate (injury frequency). There are two aspects to reporting requirements:

What is required to be reported as a work-related injury or disease
The degree of compliance with reporting requirements

So, what is reportable? That varies by jurisdiction. For WorkSafeBC with its dual role as the workers’ compensation and prevention agency for the province, a reportable injury is (or is claimed to be) an injury arising out of and in the course of employment with any of the following immediate or subsequent characteristics:

The worker loses consciousness following the injury.
The worker is transported or directed to a hospital or other place of medical treatment, or is recommended by such persons to go to such place.
The injury is one that obviously requires medical treatment.
The worker has received medical treatment for the injury.
The worker is unable or claims to be unable by reason of the injury to return to his or her usual job function on any working day subsequent to the day of injury.
The injury or accident resulted or is claimed to have resulted in the breakage of an artificial member, eyeglasses, dentures or a hearing aid.
The worker or WorkSafeBC has requested that an employer's report be sent.

Some incidents require immediate reporting whether or not an injury occurs:

Any incident that kills, causes risk of death, or seriously injures a worker
Any blasting accident that results in injury, or unusual event involving explosives
A diving incident that causes death, injury, or decompression sickness requiring treatment
A major leak or release of a dangerous substance
A major structural failure or collapse of a structure, equipment, construction support system, or excavation
Any serious mishap

Ontario’s WSIB (with its primary role on the workers’ compensation side) has the following reporting requirements written into policy:
Employers must report a work-related accident to the WSIB if they learn that a worker requires health care and/or

is absent from regular work
earns less than regular pay for regular work (e.g., part-time hours)
requires modified work at less than regular pay
requires modified work at regular pay for more than seven calendar days following the date of accident.

In Alberta, reporting requirement of injuries for occupational health and safety purposes is different than for workers’ compensation purposes. According to the Alberta OHS Act, injuries and incidents have to be reported to the Government of Alberta if they:

result in a death
cause a worker to be admitted to hospital for more than two days
involve an unplanned or uncontrolled explosion, fire or flood that causes or has the potential to cause a serious injury
involve the collapse or upset of a crane, derrick or hoist
involve the collapse or failure of any component of a building or structure necessary for the structural integrity of the building or structure.

My point is simply this: injury rate comparisons are complex. The injury rate in any jurisdiction is the result of many factors. Reporting requirement and the level of compliance with those requirements can have a significant impact on the apparent injury rates. When comparing injury rate data between jurisdictions, understanding what is reportable and how well reporting requirements are met are essential to understanding reported injury rates.

What factors encourage OH&S compliance?

2010-02-04T13:40:00.000-08:00

Recently, I’ve been thinking about compliance with safety and health requirements of law and regulation. What factors encourage compliance among workplace players (employers, supervisors, workers)? I think there are three main categories of organizations to consider:

those with strong safety cultures,
those who are uninformed, and
everyone else.

The easiest category to consider is the first one. Many workplaces are safe and secure form injury, illness and disease because of a pervasive safety culture. By this I mean that those present in the workplace put safety and health top-of-mind all the time. Supervisors continually incorporate safety-oriented content in 75% or more of their interactions with those they work with; workers are constantly alert to hazards and empowered to act to correct and control them; managers view violations of health and safety requirements as defects in their processes, training or supervision; firms act to eliminate safety and health risks to the vital human resources and the reputation of the firm. This shared culture is the predominant motivator and compliance is a natural byproduct of that culture.

The second category is characterized by a lack of safety culture without any malice or intention to violate health and safety requirements. In a sense, this group has the most to learn and gain from an intervention such as an inspection by an occupational safety and health officer. Often, these are newer firms struggling to gain markets, to expand or just to keep the business going. For this group, it is a lack of knowledge or skill rather than an active or willful disregard for health and safety that characterizes the lack of compliance. I include in this group those who may be well intentioned and even striving to develop a strong safety culture but ill equipped with the necessary knowledge, skills and abilities to make this happen.

The final category includes everyone else. Members of this category have knowledge of the health and safety requirements, the skills and abilities to comply with the health ans safety standards, but lack the internal motivation to act on what they know. For this group, compliance is more of a risk calculation:

Is the Cost of compliance less than [the probability of being caught in non-compliance times the cost of sanction(s)]? If so, comply... If not, continue in non-compliance.

A roofing firm might know that fall protection is required and even have the equipment and training to use it; however, if the risk of an inspection is negligible or, if an inspection does occur, the value of any penalty is low or non-existent, compliance may be seen as an added cost. (I shall assume that the value of non-compliance results in little or no increase in production).

For this category, there are few routes to compliance. Compliance may come as an unintended consequence or benefit of a change in process (a new machine comes with an automatic power off feature built in, for example) or if the cost equation makes non-compliance very costly.

Simple consequences of the equation follow:

If there are no penalties, there would be no motivation for this group to comply.
If the penalties are substantial but the probability of detection is very low (there are no inspectors in the region or the workplace is not easily observed), then there is little or no incentive for compliance.

There are much more complex equations in the literature but this simplified version leads to a couple obvious conclusions. Workplaces in this last category will move toward compliance as their perceptions of the cost of non-compliance increases. The perceived cost of non-compliance will increase if either or both the perceived probability of detection of non-compliance and cost of sanctions rise.

One way to increase the perceived probability of detection is announce an inspection blitz of a region or industry. Another is to increase the publicity around detected violations and penalty assessments. This does not increase either the number of inspections or the value of individual penalties for detected violations but it does increase the perception or expectation about the cost of non-compliance.

Another strategy is to increase the cost of non-compliance by a broader interpretation of penalties and sanctions. Loss of reputation through higher-profile sanctions may achieve this. OSHA in the US posts inspection reports on line. You enter a firm name and a state; you get a list of inspection reports and can determine if there are any penalties for serious violations of health and safety standards. To the extent that potential customers of a firm use this information to decide on whom they will do business with, the perceived cost of non-compliance will rise.

Ideally, we can move all workplaces into the first group—those with great safety cultures. Hopefully, a using these concepts to design compliance strategies will more workplaces toward that goal.

Why Compare Performance?

2010-01-22T09:48:00.000-08:00

This past week I was in Victoria speaking at a conference on Performance Measurement. I have been asked to present at this conference about a half dozen times and it is a real credit to the strong performance measurement culture of WorkSafeBC that this organization continues to ask for our participation.

One of the BC Reporting Principles, adopted by the BC legislature, states the following:

Public performance reporting should provide comparative information about past and expected future performance and about the performance of similar organizations when it would significantly enhance a reader’s ability to use the information being reported.

Comparative data provides stakeholders with a context to understand if what we achieved is good, bad or indifferent.

Some of our key performance indicators do have direct comparators. Thanks to the AWCBC, we can plot our administrative costs, injury rate, duration and premium against other workers’ compensation systems in Canada. Not all the comparisons are perfect. One has to take into account that jurisdictions such as Manitoba, Ontario, and Saskatchewan cover a much lower percentage (~70%) of the employed labour force than we cover in BC (~93%).

Some of our key performance indicators have no direct comparison. Our ‘voice of the customer’ program has no direct comparator in Canada regarding overall satisfaction levels for workers and employers. Some jurisdictions report on return to work at the aggregate level but none in Canada publish a statistic comparable to our indicator that measures the success of RTW for cases referred to vocational rehabilitation for that purpose. While our key performance indicator for assessing our funding status is unique, there is an industry standard that can provide another context for comparison. This AWCBC measure is reported on their website and in the Appendix to our Annual Report and Service Plan. True the the principle, this additional context is included so stakeholders have another way to judge how WorkSafeBC is performing even though there is no direct comparator to our 'Percent of Target Capital Adequacy Reserve' indicator.

WorkSafeBC also reports on a public contribution index. This measure reflects the percentage of 800 surveyed British Columbians expressing an opinion who rate WorkSafeBC as making a somewhat or very positive contribution to BC. Scores in the mid 80% range in the last four quarters are a reflection of the commitment of staff to making a difference for each and every human being they encounter. No other workers’ compensation system I know of measures performance in this fashion (or, if they do, they are not telling anyone about their results). From some historical data from firms who used to ask this question and report, we have a scale that suggests our current level is near the top of the observed range for some other BC corporations. Still, having some current external comparator in the workers’ compensation business would help our stakeholders properly evaluate our performance.

All of this is not to say we have performance measurement ‘solved’. Measurement is essential to improvement. If you can’t (or chose not to) measure something, it is debatable that you can understand it or improve it. That said, not every jurisdiction can or should measure the same things nor should they necessarily measure similar things in the same way. Performance Measurement should be strategic as well as meaningful and useful to stakeholders and those accountable for the system. More importantly, every person working within the system should be able to see how what he or she does contributes to organizational goals and influence the key indicators of the system.

Whenever possible, I encourage comparison. Sometimes that means WorkSafeBC has to generate measures for others to use; at other times, we are asking jurisdictions in Canada, the US, Australia, or New Zealand to restate their data in a way that helps us understand our own performance better.

Why compare performance? Comparison leads to understanding and that leads to questions that can make all our systems better for those we serve.

How do you measuer return to work success?

2010-01-11T15:30:00.000-08:00

Over the weekend, I received an email from Australia seeking information regarding return to work (RTW) programs and outcomes in North America. One question asked was regarding the percentage of injured workers who RTW. One might think there was a simple, common measure that would allow direct comparison across all workers’ compensation jurisdictions. In reality, however, there are few jurisdiction using the same method to measure RTW success.

The vast majority of injured workers who file workers’ compensation claims in BC and elsewhere experience a successful RTW. What percentage and how durable a return depend on the population being studied, the denominator uses and how RTW is defined. It also depends on the law and economy in the jurisdiction under study.

Many jurisdictions suggest they achieve 85-90% RTW for time-loss injuries. Most injured workers RTW with their accident employers anyway so the high percentage may not indicate anything about the effectiveness of the law, policy or program in a particular jurisdiction.

The 2008/09 Australia & New Zealand Return to Work Monitor examines these questions in detail. Using a common survey methodology that samples from the population of claims with “10 days or more compensation (including any excess) paid”, the reported statistics are among the most comparable around. The ‘employer excess’ refers to an employer deductible where the employer is responsible for paying wage loss benefits and medical costs up to certain limits. This is a common, (although not standardized) provision in Australia. Most jurisdictions in this study have legislation that requires the accident employer to return an injured worker to employment.

The Monitor reports on both ‘durable’ and ‘non-durable’ RTW. The results are summarized in that report as follows:

The RTW rate showed steady improvement between 2002/03 (83%) and 2005/06 (87%) returning to pre 2000 levels (mid 80%). There has been no further improvement, with the 2008/09 national RTW rate similar to all previous years (83%). The durable RTW rate has gradually declined over the last four years, with a lower durable RTW rate being recorded in 2008/09 (72%) to 2007/08 (75%).

More commonly, a report on RTW will be designed to meet the needs and data of a single jurisdiction. For example, a report out of the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group in November 2008 reported on ‘initial’ RTW rates. The research found 74% -78% of claims (injury year 2004-06) had an initial RTW within two quarters post injury. This climbed to around 83%-88% by four quarters and topped out at 90-93% by 12 quarters (the longest category studied). These results have to be taken in the context of the unique Texan workers’ compensation context. For a variety of reasons, it is likely the study population in Texas is more severely injured than in the Australian & New Zealand Monitor’s data.

There is no standard for measuring RTW in Canada. Many jurisdictions in Canada have mandatory reinstatement laws that require an employer to return an injured worker to employment (although BC does not have such a provision). All have some form of RTW program.

New Brunswick 2008 Report to Stakeholders states:

Ninety-six percent of injured workers who lost time from work returned to employment or their pre-employment status following their injury. Two percent were not employed immediately following their claim closure, and 2% were fully disabled and incapable of employment.

At WorkSafeBC, RTW is not just another program; it is an integral part of our strategy and linked directly to the goal of improving satisfaction, accessibility and public confidence. While most workers return to their accident employer, the focus of BC’s vocational rehabilitation efforts is on those who face significant barriers in achieving a successful RTW.

A key indicator of RTW success for WorkSafeBC is the percentage of cases referred to Vocational Rehabilitation assistance who achieve a successful outcome. Measured as a percentage of all closed cases, the results have been as high as 81.7% in 2008. Although the current economic conditions in the province are likely to result in a lower level, the importance of RTW will not diminish.

We know from research that work is good for health and well-being. Regardless of how an agency decides to measure RTW, supporting every injured worker to achieve a safe and durable RTW is and should continue to be a priority for every workers’ compensation system.

Is Bullying (Psychological Harassment) a workplace OS&H issue?

2010-01-04T10:08:00.000-08:00

A recent article noted that threats and intimidation by supervisors have risen during the current financial crisis. Whether or not this true, threats of violence or intimidation should never be tolerated. Many jurisdictions rely on a ‘general duty provision’ in their occupational safety and health regulation to require employers to assess risks and protect workers from harms that would include violence. Other jurisdictions (Federal government, BC, Alberta, Saskatchewan, Manitoba, PEI, Nova Scotia and most recently Ontario) have gone further and created specific provisions regarding violence. Part 4 of WorkSafeBC’s Occupational Health and Safety Regulation defines violence this way:

4.27 "violence" means the attempted or actual exercise by a person, other than a worker, of any physical force so as to cause injury to a worker, and includes any threatening statement or behaviour which gives a worker reasonable cause to believe that he or she is at risk of injury.

More recently, the trend has been towards more explicitly dealing with the issue of what is commonly termed ‘bullying’. Quebec and Saskatchewan lead the way in this area with specific provisions that addressed ‘psychological harassment’. Bill 168, occupational Health and Safety Amendment Act (Violence and Harassment in the workplace) 2009 was given third reading by the Ontario legislature last week. Definitions in these provisions vary but the following extract from the Ontario Bill 168 captures the main elements:

"workplace harassment" means engaging in a course of vexatious comment or conduct against a workers in a workplace that is know or ought reasonably to be known to be unwelcomed.

Quebec’s provision in its Labour Standards 81.18 is even more inclusive:

"psychological harassment" means any vexatious behaviour in the form of repeated and hostile or unwanted conduct, verbal comments, actions or gestures, that affects an employee’s dignity or psychological or physical integrity and that results in a harmful work environment for the employee.

Saskatchewan’s definition is a little more complex:

(l) ‘harassment’ means any inappropriate conduct, comment, display,action or gesture by a person:
(i) that either:
(A) is based on race, creed, religion, colour, sex, sexual
orientation, marital status, family status, disability, physical
size or weight, age, nationality, ancestry or place of
origin; or
(B) subject to subsections (3) and (4), adversely affects
the worker’s psychological or physical well-being and that the
person knows or ought reasonably to know would cause a
worker to be humiliated or intimidated; and
(ii) that constitutes a threat to the health or safety of
the worker;

Note, these provision govern workplace safety and health; they do not speak to the issue of compensability of any psychological injury that may arise. By most definitions, "harassment" or "bullying" implies a series of actions or behaviours and not "an acute reaction to a sudden and unexpected traumatic event arising out of and in the course of the worker's employment", as may be required for a mental stress claim. (See Workers Compensation Act, section 5.1(1)(a).

Is an harassment provision more effective than the general duty clause? I don’t think there is a definitive researched, evidence-based answer to that questions. On the other hand, the issue of workplace bullying is real and increasing in profile as a workplace safety and health issue. Whether through specific regulation or active education, protecting workers from harassment should be a priority.

Ontario Labour Critic calls for Competition with WSIB

2009-12-18T10:06:00.000-08:00

One might assume legislation that makes a Canadian WCB the exclusive workers’ compensation provider would extend some certainty to that status. Recent developments in other jurisdictions could dispel that assumption.

A few years ago, West Virginia was an exclusive state fund workers’ compensation insurer. Today, it faces competition from private insurers in that state. The New Zealand Accident Compensation Corporation is about to have its exclusivity removed for the workers’ compensation portion of its mandate.

Ontario’s Workplace Insurance and Safety Board (WSIB) has been under financial pressure for some time. It currently has an unfunded liability of about 47%. In other words, WSIB has about half (53%) the money it needs to cover the liabilities—the health care, permanent disability and other benefits injured workers are entitled to.

The way out of this hole is not easy. Clearly, reducing the number and severity of workplace injury and disease cases is part of the solution but unlike BC, which has the main legislated responsibility for occupational safety and health, WSIB is only one player in the prevention role. The Road to Zero strategy requires substantive and continuous reductions in the injury rate in order to have any impact on the unfunded liability.

Other options for WSIB include increasing premiums and cutting benefits. With current premiums among the highest in Canada, there is little appetite for any increase in premiums. In a sense, employers in the WSIB system are already experiencing an intergenerational transfer of costs. The unfunded liability of today is predominantly a result of injuries that occurred in the past. Slashing benefits would clearly hurt those who already are bearing the entire human and much of the financial costs of work-related injury, illness and disease.

What about improving the return on investments? As every investor knows, investments that offer higher returns carry increased risk of large losses. With market volatility and economic uncertainty the way they are today, becoming more aggressive with investment strategies is probably not a great idea.

Recently, the Labour Critic for the Official Opposition in the Ontario legislature introduced a private members Bill to open WSIB to competition. Randy Hillier, who recently sought to lead the Progressive Conservative Party of Ontario, saw his Bill 219 debated in the legislature on November 19, 2009. An explanatory note contained in the Bill states:

The Bill amends the Workplace Safety and Insurance Act, 1997 to allow an employer, at any time, to opt to participate in an insurance plan that is offered by a private-sector insurer, instead of the insurance plan established under the Act, if the alternate plan offers benefits to the employer's workers that are comparable to those offered by the insurance plan as it exists under the Act as of the date that the amendments to the Act come into force. To exercise the option, an employer is required to file a notice with the Workplace Safety and Insurance Board containing the particulars specified in the regulations made under the Act.

As with most private member Bills, this proposed legislation was defeated after some debate. It is clear that the idea of opening the WSIB to competition has resonated with some. While research would suggest that competitive workers’ compensation systems are, on average, higher cost for employers, it is likely that the large unfunded liability in Ontario will keep this issue alive for some time to come.

Ergonomic Considerations for Older Workers

2009-12-16T08:50:00.000-08:00

The idea of fitting the job to the worker is not new...but the increasing numbers of older workers in the workforce requires a fresh look at workplace standards and design.

Older workers may have very different needs from their younger counterparts. Many tables that record body measurements and ratios are based on military populations and may not be representative of the working population in general or of a particular worksite with many older workers.

What sort of considerations should one make for older workers? In a recent presentation J.M. Haight offered the following advice:

Consider older workers limitation in workspace and task design:
· Improve illumination
· Reduce heavy lifts and elevated work
· Design smooth solid flooring
· Remove control panel and computer screen clutter
· Reduce noise levels
· Focus on error reduction tools such as three way communication
· Additional time spacing between task steps
· Increase decision making time
· Reduce necessary reaction time
· Understand accommodations being made
· Educate, Educate, Educate

The Australian Public Safety Commission produced a similar
checklist of strategies and activities for an aging workforce
(Australian Public Service Commission, 2003):

Improve work task design
· Promote employees’ control over their work depending on agency needs and employee preferences
· Reduce physical loads
· Ensure good visibility of task-related information
· Improve posture
· Set reasonable work rate standards, production targets or workloads
Improve job design and work organization
· Avoid monotony, short cycle times
· Improve work scheduling
· Allow flexibility in taking rest breaks
· Allow individuals time to adapt to new tasks
· Support flexible employment conditions
Improve the physical work environment
· Minimise glare
· Ensure good lighting levels
· Minimise noise levels
· Eliminate hazards that may cause slips, trips and falls
· Make allowances for working in heat and encourage sun-safe behaviour
Support and improve people’s performance capacities
· Develop best practice performance standards
· Improve training programs
· Develop and maintain support systems
· Improve employee morale and expertise

Interestingly, this resource follows each strategy with specific recommended activities and provides a small bibliographic reference section to support each recommendation.

Zurich, another large insurer, recently published an even more elaborate listing of practical steps (Zurich Services Corporation, 2008). The listing includes engineering and administrative solutions for physical, physiological and psychosocial changes.

With same level falls (slips, trips and falls) identified as a major source for injuries in older workers, the slips, trips and fall prevention program evaluated by Bell et al. (Bell, J. L., Collins, J. W., Wolf, L., Grnqvist, R., Chiou, S., Chang, W.-R., et al. Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees. Ergonomics , 51 (12), 1906-1925) is a good resource for ergonomic strategies that have collectively been validated in a healthcare setting. The main intervention strategy elements are:

· Keep floors clean and dry
· Prevent entry into areas that are contaminated
· Use slip-resistant shoes
· Keep walkways clear of objects and reduce clutter
· Provide adequate lighting in all work areas including outdoor stairwells and parking garages
· Secure loose cords, wires and tubing
· Eliminate outdoor surface irregularities
· Eliminate indoor surface irregularities
· Check stairs
· General awareness campaign

There are other resources like Designing for Older Adults: Principles and Creative Human Factors Approaches is one such reference (Fisk, Rogers, Charness, Czaja, & Sharit, 2009). Another is “Extra-ordinary” Ergonomics: How to accommodate small and big persons, the disabled and elderly, expectant mothers and children (Kroemer, 2006) where Chapter 6 is specifically about designing for aging.

These general guidelines and resources are a start. For any particular jobsite, safely fitting the actual job tasks to the the workers who actually perform them deserves consideration.

Ergonomics and Demographics

2009-12-10T12:58:00.000-08:00

Last week I completed a graduate course on Ergonomics (OCCH 505b offered through the School of Environmental Health at the University of British Columbia). The class consisted of about a dozen students, mostly working towards a Master of Science degree in Occupational and Environmental Hygiene. The instructor was a professional ergonomist with a great background in academic, regulatory and private practice areas. The content and discussions were a great way to spend three hours every Monday evening over the last three months.

The course content covered the range of topics you might expect and a few that might not immediately jump to mind. One area we discussed was how the changing demographics of society and the labour force will require ergonomic considerations for older workers.

Demographic changes are clearly having an impact in the labour force. The average age of workers in the labour force is rising. More people are deciding to participate in the labour force well beyond the age of 65. In the US, most of this population is opting for full time work—a clear shift from the trends we saw only a decade ago. Despite these trends, there was surprisingly little research-validated data on specific ergonomic recommendations for the older workforce.

There is no standard definition of what we mean by older workers. In some research, particularly in manufacturing and construction, age 40 or 45 is used to differentiate the older worker population. In other literature, workers over the age of 55, 64, or 67 may be used to define the older population.

The research lists changes that occur to our body and mind as we age. Not everyone ages at the same rate but many common changes are important to consider when designing or fitting the job to the worker:

· stiffness Increases
· range of motion and flexibility decrease
· Hearing declines particularly at upper frequencies
· metabolism slows and weight gain often occurs
· tire more easily and take longer to recover
· eye movements may become impaired
· colour perception may change
· more light may be required for fine work tasks
· floaters and veils can appear and persist in the field of vision

Not everything about aging is bad. Some things improve with age. These include verbal and general knowledge. Age is associated with increased happiness. A recent study found a positive association between age and safety perception. Older workers have the best perceptions on safety, highest job satisfaction levels, greatest compliance with safety procedures and recorded the lowest work-related accident/injury rates.

Some researchers and insurers are beginning to provide important information for the protection older workers. I’ll provide some resources in my next post

Workers' Compensation and Social Security Disability Insurance

2009-11-24T09:09:00.000-08:00

I spent part of last week in Washington, DC at a seminar sponsored by the National Academy of Social Insurance and the U.S. Social Security Agency. The seminar focused on the fact that many of the clients served by both workers’ compensation (WC) and social security (SS).

My role in the conference was to provide a Canadian perspective and some insights into how Canadian public policy makers are dealing with the overlap between workers’ compensation and social security. More importantly, my hosts were interested in the innovations Canadians are bringing to the return-to-work priority both systems share for the clients who may be able to overcome the barriers to gainful re-employment in the labour force.

The research is pretty clear: early intervention improves return to work outcomes. Typically, access to services to assist in an early return to work (RTW) is more associated with workers’ compensation than Social Security Disability Insurance (SSDI) or Canada Pension Plan-Disability (CPP-D). Consequently, public policy that increases the scope of coverage for WC tends to increase access to programs and services of this population that would not otherwise have such access. Since many of those who are outside the scope of WC coverage (for example, some jurisdictions exclude, domestic workers, out-workers, farm labourers and self-employed from coverage) are workers who may have limited access to alternative employment, any expansion of WC coverage that includes these populations has the potential to help some of the most vulnerable workers return to work.

In my presentation, I noted that some jurisdictions have mandatory reinstatement provisions in their WC legislation. These provisions require an employer to take an injured worker back to employment. Some jurisdictions go further and require the employer to accommodate the worker to the point of “undue hardship”—a significantly higher test than mere ‘reasonable accommodation’. The big stick of legislation is not unique to some Canadian jurisdictions. Many Australian jurisdictions, for example, require employers to return injured workers to employment.

Since WorkSafeBC’s legislation contains no direct mandatory reinstatement provision, other approaches are emphasized. For example, WorkSafeBC offers a rebate of premiums to employers who qualify for a Certificate of Recognition. After substantiating through an audit that a firm has a prevention program in place that exceeds the regulatory minimum and has an injury management/Return to Work program in place, the firm may qualify for a 15% rebate. This can provide a substantial carrot to get and keep the attention focused on primary prevention and disability management that may help all workers—not just those who may suffer a work-related injury.

In the question and answer session, I was asked how WorkSafeBC is financed and how this compares with the typical US workers’ compensation insurer. I noted that WorkSafeBC is the exclusive insurer of work-related injury, the sole adjudicative authority, policy maker, workplace health and safety regulator and inspectorate for the province (like OSHA in the US). WorkSafeBC is funded by premiums that average about $1.56 per $100 of assessable payroll and that premium covers all WorkSafeBC’s functions (in the U.S., the quoted base or book rate may not reflect assessments or levies that finance research, oversight, appeals, and state-OSHA costs).

In follow-up questions, I was asked what I meant by assessable payroll. In many places, workers’ compensation rates apply to total payroll as opposed to the limit WorkSafeBC and most other Canadian WC boards place on payroll per person (currently $68,500). If we stated WorkSafeBC’s premium in terms of total payroll, we estimate the rate would come in at about $1.33 per $100 of payroll.

It was clear from the interest expressed in questions both during and following the session that many of the researchers in the audience were intrigued with the apparent low cost, relatively high benefits and strong return-to-work outcomes achieved in British Columbia for our workers and employers. If you are interested in seeing the presentations from this event, you will find them posted on the past events section of the NASI.org site...look for the November 18, 2009 seminar listing.

What does Workers’ Compensation owe Francois Bareme?

2009-11-13T12:14:00.000-08:00

Every workers’ compensation system has some way of deciding what payment a worker should receive for permanent disability. Some systems are based on impairment or non-economic loss while others are based on disability with its implied economic loss calculated in some manner or other. Still others are based on a combination of the two concepts. Commonly in workers’ compensation, schedules of disability exist that relate impairment or disability to some standard. In Canada, we might refer to these as Disability Schedules. In several European sources, I noted that these schedules were called “Baremas” . I wondered about the origin of the word and was fascinated by what I found.

In medieval times, Germanic law related the loss of an arm or an eye to the ‘wergeld’ or ‘manngeld’, the compensation that was to be paid to the family for the killing of a free man. Even pirates had schedules in the articles that governed their enlistment. In Under the Black Flag: Exploits of the most notorious pirates, Don Carlos Seitz lists the articles from a 1723 voyage under Captin John Phillips; one article reads:

If any Man shall lose a Joint in time of Engagement, shall have 400 Pieces of
Eight; if a Limb, 800.

Enter the French mathematician, Francois Bareme [or Barreme] (1638?-1703). He created and published many mathematical tables for ease of use and consistency in commerce. The French word for a ready-reckoner, barême or barrême, is a reference to him. Bareme took the sums that were commonly used for the loss of body parts and restated them as a percentage of the compensation that would be granted for compensation for the death of a free man. Subsequently, such listings of body parts and percentages in many personal injury compensation schemes became known as Baremas. Today, the most complex Barema would be the AMA Guides. In Spain, the Baremo, as it is known, is a mechanism that allows users to consistently evaluate bodily injury and assess compensation for victims of motor vehicle incidents (for permanent disability systems, it uses a point system to calculate a rating from 0 to 100 that determines the compensation).

The scale and method of calculating compensation varies with the barema used and the jurisdiction. I recently wanted to know how various systems might rate the loss of an eye. Since some jurisdictions are not limited to just workers’ compensation, these may not be strictly comparable but I thought the variation was interesting. In WorkSafeBC’s Permanent Disability Evaluation Schedule, and industrially blind eye is evaluated as a 16% disability, enuculeation at 18%. In Belgium, total loss of vision in one eye is rated at 30% disability. The English Barema uses 40% while the French use 25% and in Iceland, the loss of vision in one eye is rated at 20%. There is even a wide variation in Scandinavia with the loss of vision of one eye rated at 20% in Denmark and Norway and 14% in Sweden while the actual loss of one eye is rated at 20% disability in Denmark but 25% and 17% in Norway and Sweden respectively.

Of course, the final result for the injured worker will be based on more than a percentage of disability. A low percentage of a high wage rate may provide a greater benefit than in a system where the maximum wage rate is pegged at a low level.

There is no one right percentage of disability to apply in this example. What is right for one jurisdiction is not necessarily right for another. The impact of the loss of an eye in one society (and its related economy) may be quite different than in another. That said, the equity is critical. Bareme’s intent in creating tables was to standardize and eliminate error—a goal that still applies today.

Workers' Compensation and a Uniform or Flat Assessment Rate?

2009-10-30T11:54:00.000-07:00

I received a call last week about funding workers’ compensation systems. The caller asked why we don’t just charge one rate for all industries. For those of us in North America or Australia, this notion may seem odd since our systems all have different rates for different industries based on some sort of classification system. On the other hand, those covered by Canada Pension Plan-Disability or Social Security Disability Insurance in the US are familiar with the idea of a single contribution rate paid for an insurance. For workers without workers’ compensation coverage, CPP-D or SSDI may be the only insurance they have for work-related injury that precludes them from earning. Is there any good reason for having assessment rates that varies by industry? Are there any advantages to having a single rate system?

First, let’s talk about the rating systems we have. In BC, the average WorkSafeBC assessment rate (premium) is $1.56 per $100 of assessable payroll. Industries with higher costs pay more: Heavy construction, steep slope roofing, steel frame erection are at the high end, around $12 while financial institutions, computer software design and production pay between $0.08 and $0.13 per $100. Having a rate structure has implications. There are costs for creating and monitoring the classification system, assigning firms to various classification units and managing the inevitable conflicts that can occur as a business changes or argues that it should be classified in a (usually lower) classification.

A single rate system, on the other hand, requires none of these costs. Canada Pension Plan contributions are calculated as a simple tax on payroll (currently the employer and the worker each pay 4.95% of earnings for CPP). That’s it. Simple. But is it fair? In one sense, it is equal treatment for all and for non-work related causes of severe and prolonged disability, it likely is fair. Each of us bears a risk for serious disease that could debilitate us from work so it makes sense that all should share equally in the cost.

Doing the same for a workers’ compensation scheme has been proposed. Sir Owen Woodhouse proposed a flat rate for employers for their part of the New Zealand Accident Compensation scheme back in 1967. In defense of Woodhouse, his concept extended well beyond work-related injuries and in the context of a no-fault universal scheme of social insurance, the uniform rate idea is attractive.

I am unaware of any system in Canada, the US or Australia that have implemented a flat rate system. In Canada, the issue of a uniform assessment rate was considered by Sir William Meredith who writes:

It is the purpose of my draft bill to empower the Board in determining the roportions of the contributions to be made to the accident fund by employers to have regard to the hazard of each industry, and to fix the proportions of the assessments to be borne by the employer accordingly, and not to require that the proportions for each class or sub-class should be uniform…

So, in practice, workers’ compensation systems use classification systems that result in different rates being assessed for different industries according to ‘hazard’ which includes the human and financial costs associated with the wage structure, frequency and severity of injuries that occur within an industry. A uniform rate, it may be argued, would be tantamount to a subsidy. In the BC example noted above, a uniform assessment of $1.56 would be very attractive to steep slope roofers and would be a significant cost burden to financial institutions whose assessments would be used to offset the costs in sectors where injuries were more frequent and/or costly.

Similar arguments apply within sectors and are often used as a justification of experience rating or rate modification…but that is a discussion for another day.

Seasonal Agricultural Workers and Workers' Compensation

2009-10-22T08:32:00.000-07:00

Last week I attended a symposium on health and safety issues for farm workers with a focus on those entering under the Canada as Seasonal Agricultural Workers Program (SAWP) from Mexico. I have been tracking the workers’ compensation issues raised by the entry of British Columbia into this program about five years ago.

What we know about this group of workers is that they are vulnerable on several levels. Language, culture, limits on the ability to meet with others in the community, long hours, fear of removal, limited knowledge of rights, isolation due to location are but a few of a long list of factors that make this population among the most vulnerable of workers. While these workers have the same rights under workers’ compensation laws and the Occupational Safety and Health Regulation, fully exercising those rights may be hindered by the these factors.

What we heard from the researchers confirmed what we already know: many temporary foreign workers are reluctant to report injuries and violations of the Regulation. Addressing the factors that contribute to this situation isn’t easy but is important.

Letting these workers know about their rights isn’t simply a matter of sending out a booklet or posting a page on the internet (although these actions help to some degree). Unlike other worker populations, workers under SAWP, other programs or even working without legal authority will, by definition, tend to be ‘new’ workers (new to Canada, new to the jobsite, new to tasks they will be performing). As we know from other research, newness itself increases risk (see IWH brief on this topic). Finding ways to better address the needs of this vulnerable group will be a growing challenge as the number of workers in this category increases.

In other forums, I have heard about innovative practices and approaches to serving agricultural workers, particularly temporary foreign workers from Mexico. In Washington state, Spanish radio vignettes have been designed and broadcast with plot lines and dialogue that mirror health, safety and compensation rights. In Ontario, all SAWP are covered by the provincial medical plan (OHIP) without the typical waiting period. In BC, WorkSafeBC and FARSHA have developed materials, delivered training and increased services designed to reach these workers on jobsites throughout the province.

One additional point came out of the symposium that is worth noting. The general category of ‘farm worker’ includes several vulnerable worker types. Canadian citizens and permanent residents may be subject to the same language and cultural barriers as workers under the SAWP groups (Mexico and the Caribbean); Refugee claimants with authority to work will have additional barriers as will other workers who may have no legal status at all in Canada. For the sake of all these vulnerable workers, new approaches may be necessary to educate these workers about the workplace risks they face, how to protect themselves and how to exercise their rights, protections and compensation.

What will drive the Future of Workers' Compensation?

2009-10-14T10:58:00.000-07:00

Last week I was at the AWCBC Learning Symposium. The theme of the event was “Time Capsule” and I was asked to speak about the future of workers’ compensation.
My talk outlined three categories of forces that are driving change in workers’ compensation:

Factors that are substantially beyond our direct control like economic cycle, demographic shifts, and broad societal trends.
Public policy decisions that we do not necessarily control but which we may influence. This category includes the areas of who is covered, what is covered and the degree to which workers’ compensation and prevention are aligned and integrated.
Decision we make and direction we take that are substantially within our control.

The details of these forces and the analysis behind them are beyond the scope of this blog but there are some clear themes that emerge that may be summarized by the following points:

Economic cycles, demographic shifts and societal changes will continue to impact workers’ compensation systems—outside our direct control but with predictable consequences. We need to take that step and have ready analysis of the effects of past recessions and expansions on investments, employment, injury volumes, injury rates, duration of disability, etc.
The scope of coverage will trend toward universal coverage and greater prevention responsibilities—something we may anticipate and be involved in. In jurisdictions with less than 80% of the employed labour force covered by workers’ compensation laws, the trend will be toward greater inclusion within scope and the evidence of work-relatedness will increase in what is covered. Here workers’ compensation systems can play a vital role in identifying where coverage should be extended for the mutual advantage of workers, employers and the broader society.
Occupational Diseases will drive our legislative, regulatory, policy and practice directions particularly in the area of
• Stress, Psychological Injuries
• Fatigue, human factors
• New materials and processes
• Old materials, new applications
• New workplace relationships, participants
• New zoonotic disease, new vectors

Based on this third point, Expansion of what and who is covered is likely.

I also extended my analysis to capture a other changes workers’ compensation systems could anticipate. The first was Harmonization. Workers’ Compensation and Prevention coverage, policies, and practices will trend toward greater similarity. Next was Integration, by which I mean workers’ compensation systems will trend toward an expanded mandate and the responsibility for prevention. I added an obvious prediction around Automation. Our work will be increasingly technology enabled… and dependent…even the parts of our work that require high levels of personal interaction. This is both a blessing and a curse since this dependence becomes one of our greatest vulnerabilities.

In some ways, my final prediction is an extension of the others. Cooperation will become a key driver in workers’ compensation. Strategic alliances, direct partnerships, shared resources such as systems and call centers will grow among workers’ compensation agencies and between individual agencies and their stakeholder partners.

In the future, the future that we must enable, we will see what Malcolm Sparrow calls the "Character of Harms" as a driver of what we do internally, externally and most importantly across traditional boundaries.

I can only add my biggest fear: that 20 years from now, workers’ compensation and prevention personnel will look back on what we are doing now and ask: What were you thinking? What did you know—or should have known—and why didn’t you act?

Workers' compensaiton state funds: Are they comparable to private insurers?

2009-10-05T11:01:00.000-07:00

Workers' compensation insurance is ubiquitous in developed nations but how that insurance is delivered varies greatly. In most of the world, workers' compensation is part of social insurance structures. In Canada, the United States, and Australia workers' compensation is generally legislated by individual states or provinces. In Canada, every province and territory has a workers' compensation act as does the federal government. The same holds true in the U.S. and Australia in that each state and the federal government has legislation governing workers' compensation. Options for administration delivery of workers' compensation, covery a wide spectrum from [mostly] private workers' compensation insurance markets [with varying degrees of state oversight and regulation] to [mostly] state delivery models.

In Canada, there is only one model: provincial workers' compensation boards or commissions each the primary insurer in their respective jurisdictions. Some people refer to this model as the "exclusive state fund" model or "monopolistic state fund" model. The latter is less accurate in that many jurisdictions allow for private disability insurance over and above the workers' compensation coverage and to serve populations outside the scope of coverage offered by the state.

In the U.S. there are two main types of state funds (each with two main subtypes): Exclusive state funds (with or without a provision for self insurance), Competitive state funds (which compete with private insurers across a broad market or who serve a more limited market of specific sectors and often acting as the insurer of last resort). In the U.S. there are about 25 state funds, four of which would be considered exclusive state funds and closest to the Canadian boards and commissions.

Are state funds comparable in terms of efficiency with their private insurance counterparts? This question is frequently raised, usually with the supposition that exclusive state funds will somehow be inefficient and therefore have higher costs. Defenders of state funds note that some state funds were create precisely because of private insurance market failures. They note that several states created competitive state funds to create a more vibrant market and to ensure all those who need (or were required by the state to carry) workers' compensation insurance would have a place to go. In order for state funds to compete, like any other competitor in a market place, they must face similar costs and obstacles as their competitors. If they were inefficient, by definition, they would be less competitive and lose market share. For exclusive state funds, the economies of scale and scope, absence of costs associated with gaining or retaining market share, and the presence of almost perfect information on risks and costs in the market are often cited as offsets any inefficiencies inherent in exclusivity.

One of the premier consulting firms in the industry, Conning, recently completed a study on state funds in the U.S. A summary of their findings is available at this link. The summary notes:

Workers' compensation state funds currently write a quarter of insured workers'
compensation net written premiums. Although sometimes thought of as a "market of
last resort," despite their higher loss ratios, state funds' financial results are on par with the industry as a whole....As we show in this study, the primary mission of state funds is support of their local economies. This includes not only promoting fair access to insurance, but also the maintenance of a safe and productive workforce. Their ability to provide effective loss prevention and control services, and link the outcomes directly to insured costs, has helped state funds succeed in their mission.

This finding adds to the weight of evidence in favour of the competitiveness of workers' compensation state funds. And the advantages of the state fund model in meeting other public policy objectives --particularly in regards to workplace safety/prevention [see my earlier post]--continues to make the creation and maintenance of such funds a viable alternative to a purely private market for workers' compensation.

Each model has its advantages and disadvantages; clearly each jurisdiction has something to learn from the full range of models out there.

Information Exchange: Learning and Sharing in Workers' Comp

2009-09-29T09:50:00.000-07:00

It has been an interesting couple of weeks for me. We had an expert in workers’ compensation from Michigan visit our offices, a telephone meeting with vocational rehabilitation experts in South Australia, an internal request for a contact in Sweden, and a data request for a project involving workers’ compensation in Victoria Australia, New Zealand and British Columbia. Then we had a visiting delegation from Russia. Last week I was on a panel with German representatives from the International Social Security Agency (ISSA) speaking to an audience of Canadians, Germans, Australians, Canadians, Americans and a representative from Taiwan.

No one jurisdiction has a monopoly on good ideas. When looking for alternative policies or programs, seeing how other agencies have attacked similar issues can both inform your decision-making and act as an early warning system for problems that might be encountered.

The act of collecting data and policy alternatives from others, however, imposes certain obligations on the requester. First, a basic understanding of the context of each country’s workers’ compensation environment is essential. Who is covered, what is covered, how does the OH&S role / prevention mandate integrate with the workers’ compensation mandate, how are disputes handled—all are questions that need to be asked and the answers understood before the data can be properly assessed and interpreted.

The other obligation is reciprocity. If I ask you about your system, your results or how you approach a particular policy, it stands to reason that you may want to ask similar questions about my system, results or policy. Often, answering such questions will take time and resources when you can least afford them. It is important to realize that the same will be true when the tables are reversed.

I am constantly blown away by the cooperation and generosity of others in helping me understand their systems. Wherever possible, I try and reciprocate. Rarely do I find that my requests for information are ignored or dealt with in a perfunctory way.

My point in this blog is simply this: we live in an information age where data is plentiful but meaningless without context. That context can only be gained by asking questions, learning from others and sharing insights and knowledge. And it’s a two way street.

So, to all of you who end up answering my requests for information, thank you!

Workers' Compensation Funded Status and Funding Policy

2009-09-20T10:54:00.000-07:00

Last time I wrote about why funding status is important. The recent economic crisis has had an impact on the funding status of many workers’ compensation systems. Since most use fair value accounting, many saw the value of assets at the end of 2008 and hence their funding levels decline dramatically.

Funding status is typically defined as assets (including reserves) over liabilities with 100 representing a ‘fully funded’ position. Using published Annual Reports from individual workers’ compensation funds in Canada, the funding levels for 2008 looked like this:

[corrected Jan 18, 2010]
WorkSafeBC 115.5%
WorkSafeNB 87.7%
WHSCC Nfld 77.3%
WSIB Ontario 53.5%
WCB PEI 89.2%
WCHSB Yukon 105.2%
WCB Sask 101.8%
WCB Alberta 111.7%
WCB NS 59.9%
WCB MB 106.6%
CSST 69.9%

Funding status using this measure is not the same as the ‘funding policy’. Alberta, for example, has a funding policy where “the Accident Fund is considered fully funded when it is within the Funded Ratio target range of 114% to 128%”. Saskatchewan and BC have alternative funding policy measures that are more complicated. Current funding status of both systems, if expressed using the standard calculation discussed above, would be greater the 100%.

To get around the differences, the AWCBC publishes key statistical measures for all Canadian boards using a standard calculation (total assets divided by total liabilities times 100) to generate a ‘Percentage Funded’ standardized statistical measure. These are compiled annually and reported on their website. Because of timing of release of information, however, the results are usually published about eleven months after the calendar/fiscal year end. As of this writing, the results for 2007 are the most recent ones available at that site.

The point here is that there is no one ‘right’ funding policy or strategy. When comparing systems, you need to look beyond the published measure a system may post. The standard calculation helps put the systems on an equalized basis but the funded percentage may not tell the whole story

Workers' Compensation and Unfunded Liabilities

2009-09-11T08:21:00.000-07:00

A relatively new workers’ compensation officer asked me to explain ‘unfunded liability’ and why this would be a concern to a workers’ compensation system. The officer’s interest arose from a reading of the Ontario WSIB Annual Report for 2008 which stated:

Due mainly to the investment loss, the unfunded liability has increased to$11,469 million at the end of 2008. This is $3,375 million higher than at the end of 2007, when it was $8,094 million. The WSIB’s funding ratio has decreased by 12.9 percentage points to 53.5 per cent on December 31, 2008, from 66.4 per cent at December 31, 2007.

Funding workers’ compensation systems requires a longer view than most insurance systems. Injuries in one year may not be fully resolved within that year. In fact, many cases will require medical treatment, rehabilitation, and medical aid expenditure for decades. Permanent disability cases may also require funding for many years. Add in the cost to administer the claim and expenditures over time and it is plain that the true total cost of a claim will not be known for many years. For the workers’ compensation insurer, these future costs are ‘liabilities’.

Since payments against a claim will be made over time, workers’compensation insurers can estimate the amount of money they need today to make those payments into the future. Amounts that will be paid in the future are ‘discounted’ so they can be stated in current dollars. Using actuarial principles, past experience, and some assumptions about investment returns the insurer can place a ‘present value’ on the cost of the claim at or near the time the injury occurred. This present value is also known as the incurred cost of a claim. As long as the insurer has collected enough in premiums to cover the incurred costs of all claims, receives the investment returns expected and experiences costs over the lifetimes of the claims as expected, the insurer will have just enough money to cover all the costs associated with all the claims that arose in a given year. The idea is simple: premiums collected from current employers in a year should be sufficient to cover the cost of the work-related injuries incurred in that year.

Of course, things do not always go as planned. The costs of medical treatment may increase at a rate greater than expected. Investment returns may be less than expected. By comparing the current present value of all claims to the current value of all assets that may be used to pay those claims, an insurer can determine its funded status. If the value of its assets equals the present value of its liabilities, the system is ‘fully funded’. If there are more liabilities than assets, the system is under-funded and is said to have an ‘unfunded liability’. If the valuation of current assets is made when the market for those assets is depressed, the size of any unfunded liability will be larger than on a day when the market is elevated.

So,what if there is a large and persistent unfunded liability? Not necessarily. The situation may improve with higher investment returns, actions to achieve lower patterns of expenditure such as improved return to work outcomes and better health outcomes with lower disability. If these don't work, at some point the unfunded liability must be funded. Assuming benefits are held constant and patterns of disability do not change, the only other source available to cover the unfunded liability of past claims will be premiums or assessments paid by current employers. In effect, using premiums or assessments to offset an unfunded liability is an inter-generational transfer of the cost of work-related injuries from employers in the past to current employers.

There are other measures of financial health of a workers’ compensation system but the funded status is one of the most common in Canada. The AWCBC includes funded status in its report of key statistical measures. The 2007 results for all Canadian boards are the most recent funding ratios available without going to individual annual reports.

A new lecture series at SOEH

2009-09-02T13:18:00.000-07:00

September in North America tends to be associated with the end of summer vacations, a return to school, and the resumption of routines. For me, I am back from a summer break that included several conferences and speaking engagements and am heading back to university for an evening class (on ergonomics) and attendance at a weekly midday seminar series that many of you may find of interest. For a student of workers' compensation and OH&S, this last item is of real interest.

For the past few years, the School of Environmental Health (SOEH- the new, shorter name for the School of Occupational and Environmental Hygiene) at the University of British Columbia has offered a free Friday Seminar Series. Anyone can drop in on campus or connect via the internet for a weekly hour-long seminar on topics related to occupational and environmental health.

Not only are the seminars interesting in themselves, attendance either in person or online can earn Certification Maintenance credits for a number of professional associations (ABIH, CRBOH, BCRSP have pre-approved the series and other associations may grant credits upon application). As an added bonus, past sessions are archived and freely available on line for anyone who wants to review them.

As with any online system, there can be glitches but I have participated in these seminars from Australia, New Zealand, Hawaii, the eastern and southern US and from about half the provinces in Canada with minimal difficulty. The “live classroom support” is supported in part through funding provided by WorkSafeBC, a longtime partner of SOEH.

Check out the series at the following link. http://www.soeh.ubc.ca/Seminars/default.stm

Workers' Compensation and the US Healthcare Debate

2009-08-18T12:37:00.000-07:00

I’ve been traveling in the US for the past few weeks. I had a speaking engagement in Washington DC and then attended the AASCIF conference in Portland, Maine. Wherever I went, the main topic of conversation was the US Healthcare reform and inevitably, I would be asked about how the system works in Canada and how Workers’ Compensation fits in with the Canadian model.

First, the concern over healthcare costs in the US workers’ compensation community is high. At the AASCIF conference, several speakers noted that healthcare now represents 60% of the benefit spending of workers’ compensation systems in the US. In Canada, indemnity benefits still far exceed health care costs (Healthcare accounts for about 26% of benefit expenditures [excluding claim administration] at WorkSafeBC).

In the US, I am told there is some suspicion that some workers without healthcare coverage feign a work-related injury to obtain healthcare and indemnity benefits for non-work injuries. With about a third of Americans lacking medical insurance, the impetus for such supposition is obvious. Yet, in Canada where there is universal healthcare coverage, the same reasoning would support a conclusion that such misapplication of workers’ compensation benefits to cover healthcare is unlikely.

For work-related injuries, workers’ compensation insurers in Canada are first payers just as they are in the US. While Canadian workers’ compensation insurers benefit from the lower costs that prevail in a single payer system, the healthcare costs of work-related injuries must still be reflected in the cost of workers’ compensation insurance to the employer.

It is important to note that any work-related injury or disease healthcare costs not paid by workers’ compensation will usually be paid by the provincial medical insurance plan. Since healthcare is actually funded by more than the nominal healthcare premiums paid by individuals and families, work-related injuries that are not covered by workers’ compensation are a burden on taxpayers and a subsidy to business or work that gave rise to the injury or disease.

As the debate over healthcare reform continues, it is possible that workers’ compensation will be included in at least some of the proposals. The status quo with workers’ compensation as the first payer for work-related injury and disease is conceptually the easiest and most direct method for workers protection. Failure to capture the full healthcare cost of work-related injuries and disease would remove an important incentive to invest in worker safety and health.

Workers' Compensation: Recovery and Return to Work (RTW)

2009-07-15T12:03:00.000-07:00

In my view, Prevention and Rehabilitation/Return-to-Work are the two main pillars of workers’ compensation; the ‘compensation’ part is just what we do after prevention fails and before the worker returns to work.

I view the early, safe and durable return-to-work (RTW) of an injured worker as the hallmark of a successful health outcome for an injured worker. Many workers and employers are under the mistaken impression that RTW should only occur after the worker is ‘back to normal’ or ‘100% recovered’.

To help correct this impression, I often use this recovery curve diagram to depict how the workers’ compensation system works. It shows the level of health functioning (H0)the worker has prior to the work-related injury and depicts the sudden, drastic drop in health function caused by the injury. During the initial post-injury period, the worker is Totally Temporarily Disabled(TTD). As the worker recovers, there will be a point where the worker is no longer TTD but is Temporarily Partially Disabled, (TPD). During this phase of the recovery curve, many workers actually return to work. As any practitioner of Disability Management will tell you, returning to work can be an effective therapy. For many workers, the demands of their regular jobs may be met at a level of health functioning lower than (H0). This makes sense since few jobs require a worker to be at the peak of their functional health capacity to adequately and safely perform their duties.

Recovery continues until the worker reaches a medical ‘plateau’ or what some call ‘maximal medical improvement’. Most compensation systems require that temporary disability payments cease once the worker’s condition plateaus but in practice about 90% of workers return to work prior to that point.

If the worker has permanently lost some functioning, (an amputation of the hand, for example) the worker will never return to the pre-injury level (H0). A new maximal level of health functioning will be established (H1). Conceptually, the difference between H0 and H1 is a permanent functional impairment. Depending on the workers’ compensation system, this impairment may result in a permanent partial impairment based on function or translated into a Permanent Partial Disability (PPD). As long as the level of health functioning is above the requirements for the worker’s particular job, the worker can RTW; if there are parts of the job that demand more than the current level, job modifications or other strategies (like providing lifting devices, restricted duties, or shorter shifts) may allow the worker to RTW during TTD).
RTW to the accident employer is usually the best alternative. Some systems (Ontario and Victoria Australia are two examples) require employers to take injured workers back into employment while others (British Columbia and Washington State for example) do not have such ‘mandatory reinstatement’ provisions in their legislation.

Promoting early, safe, and durable return-to-work is a priority for most workers’ compensation systems. WorkSafeVictoria recently posted videos for workers, employers and agents that continue that jurisdiction’s long-standing tradition of encouraging RTW. These videos are worth a view.

Workers’ compensation and Social Insurance Disabilty

2009-06-29T14:11:00.000-07:00

In much of the world, workers’ compensation is part of larger social insurance schemes. In Canada amd the US, social security systems are separate from workers’ compensation but there can be overlaps in coverage and varying treatments on the benefits payable.

On the contribution side, workers and employers are generally required to contribute to a social security system. In Canada, that system is called the Canada Pension Plan (CPP) in most of Canada and the Quebec Pension Plan (QPP) in that province. In the US, the Social Security system fulfils this role. Each of these plans has its own provisions for cases involving disability. In the case of the Canada Pension Plan, an individual with a condition that is ‘Severe and Prolonged’ may be eligible for a benefit from CPP Disability.

A worker who develops a debilitating condition not related to work may collect from the appropriate social insurance plan. Where the condition or injury that gave rise to the disability is work related, the worker may or may not have eligibility under both the social insurance disability plan and the appropriate workers’ compensation legislation.
Where workers’ compensation and social insurance are both potential payers, there are three main public policy alternatives:

Fully stackable- the worker may collect from both plans
Fully integrated- the worker collects full entitlement from one plan (the ‘first payer’) and an amount equivalent to the full entitlement from the other plan less anything payable from first payer
Partially integrated- The worker’s entitlement to one plan is reduced or ‘offset’ by some portion of the entitlement of the other insurance.

Currently, workers in British Columbia experience a partially integrated system whereby WorkSafeBC deducts 50% of the applicable CPP disability benefits from a worker’s permanent disability award where the injury occurred on or after June 30, 2002. Of course, this only applies if the worker is eligible for CPP Disability. Workers with a job-related injury in Quebec, however, go to the CSST (Quebec’s workers’ compensation system) and cannot apply to the Quebec Pension Plan.

In the US, the offset usually works the other way around. According to the National Academy of Social Insurance’s fact sheet of the topic:

An offset for concurrent receipt of workers’ compensation was contained in the original 1956 Social Security disability program, eliminated in 1958, and reinstituted in 1965. The 1965 Social Security Amendments required that Disability Insurance benefits be reduced when the worker is also eligible for periodic or lump-sum workers’ compensation payments, so that the combined amount of workers’ compensation and Social Security disability benefits does not exceed 80 percent of the worker’s average current earnings. The combined payments after the reduction, however, will never be less than the amount of total Social Security disability benefits before the reduction …Under the 1965 law, the Social Security disability benefit will not be reduced if the state workers’ compensation law or plan provided for a reverse offset (a reduction of the workers’ compensation benefit of a worker also receiving Disability Insurance).

Each of the public policy alternatives has its pros and cons. There is no one right way to provide workers compensation and social security benefits. It is important, however, to be mindful of the interplay between the two systems when considering either a change in public policy or comparing benefits across jurisdictions.

What's Climate Change got to do with Workers’ Compensation?

2009-06-22T14:03:00.000-07:00

As Al Gore’s “An Inconvenient Truth” aptly displayed, climate change has consequences for all of us. Most of us are workers so it follows that climate change will have consequences for workers’ compensation and prevention organizations.

Last week, the U.S. government released a new global warming report entitled "Global Climate Change Impacts in the United States.” It lists some of the likely consequences of climate change. As you read each of these, it is easy to imagine occupations that will feel the brunt of the change in a way that will influence safety and health. I’ve selected a few consequences and added a few but you may have others:

Heavy downpours - Occupational risks associated with flooding, washed out roadways, impaired visibility for drivers and others on highways, undermining of rail and bridge supports, silt debris buildups, contamination of water runoff.

Heat Extremes- Occupational risks associated with deformation of rail tracks, overheating of vehicles, delays and dangers in road building and repair, softening of asphalt, changes in lift properties of aircraft

Drought areas expand- increased wildfires, decreased visibility (blowing smoke, dust).

More intense hurricanes- storm surge danger, increased risks to safety and rescue workers, disruption in supply systems, dangers due to weakened manmade and natural structures (trees).

Health impacts- increase in occupational heat stress, exposure to waterborne diseases, poor air quality leading to exacerbation of underlying asthma, diseases transmitted by contact with insects and rodents new to the area.

The impacts on human health will also impact workers who are caregivers. These workers not only face the direct effects of the climate change but the indirect effects of caring for others impacted by heat, cold, flood, ozone/air quality, waterborne and zoonotic diseases.

The report provides detailed analysis for each geographic region. For the Northwest, the area just south of British Columbia, the report suggests increases in winter precipitation and decreases in summer precipitation, changes in snowpack, stream flows, sea level, and forests. The report cites the BC pine beetle experience:

The mountain pine beetle outbreak in British Columbia has destroyed 33 million acres of trees so far, about 40 percent of the marketable pine trees in the province. By 2018, it is projected that the infestation will have run its course and over 78 percent of the mature pines will have been killed; this will affect more than one-third of the total area of British Columbia’s forest.

The consequences for industries and workers dependent on the forests are obvious.

Most of the trends listed are already well underway. Creating greater awareness of the risks that come along with the consequences of climate change—and what to do to mitigate them—needs to be a priority.

Wellness and Workers' Comp

2009-06-15T15:35:00.000-07:00

A recent column in the Insurance Journal, entitled "Workers' Compensation Industry Worried About Obesity Claims", raised the issue of one chronic condition and triggered thoughts about others. Many workers with underlying conditions are in the workforce. They carry on their tasks and duties competently. Many observers do not even know they have an underlying health condition. Diabetes, hypertension, asthma and many other conditions do not interfere with their other work duties but can have an impact on recovery if the workers is injured.

Obesity is one condition in this category. Many of us are over our ideal weights and we are told this may impact our health but what about our safety and recovery after injury. A recent Duke University study found:

...obese workers filed twice the number of workers' compensation
claims, had seven times higher medical costs from those claims and lost 13 times more days of work from work injury or work illness than did non-obese workers. ...and obese workers in high-risk jobs incurred the highest costs, both economically and medically.

The full study (Ostbye, Dement, and Krause "Obesity and Workers' Compensation: Results From the Duke Health and Safety Surveillance System" Arch Intern Med. 2007;167(8):766-773) is available on line.

The Duke study raises an important general question for workers' compensation and prevention organizations: What role, if any, should workers' comp and OH&S organizations play in promoting workplace wellness?

Findings like those from the Duke study suggest workers' compensation and prevention organizations have a vested interest in the overall wellness of workers. By inference, assisting workers to address non-work-related health issues like obesity, lack of exercise, and work-life banance could reduce the number of workplace injuries serious enough to result in claims as well as the duration and associated medical costs of those claims.

The link between wellness and controlling workers' compensation costs is what's behind WorkSafe Victoria, Australia's $218 million investment in WorkHealth. The program includes workplace-based 'health checks', access to advice, and education programs to help workers reduce their risk of chronic disease.

The idea behind this strategy appears sound. It is an investment in societal change with local benefits to the workers and employers in the long run. It is thinking outside the traditional workers' comp box and will be fascinating to watch.

Metals, arsenic, dusts and fibres: Workers’ Compensation and Prevention concerns

2009-06-09T10:52:00.000-07:00

I’ve written about the International Agency for Research on Cancer (IARC) in an earlier blog post. IARC recently released a reassessment of the previously classified Group 1 carcinogens to identify additional tumour sites. The assessment will be published in apart C of Volume 100 of the IARC Monographs.

A news story in The Lancet (Vol 10 May 2009) carried a table that lists Group 1 agents, Tumour sites for which there is sufficient evidence in humans and other sites with limited evidence in humans as well as the established mechanic events that lead to cancers in humans. Among the Group 1 agents are metals and their compounds (Arsenic, Beryllium, Cadmium, Nickel), Asbestos, Erionite, Silica Dust, Leather dust and Wood dust.

While the more or less usual associations between Asbestos and Lung Cancers, Silica and Lung Cancers, and Wood dust and nasal cavity are displayed in the table, the column on “other sites with limited evidence bears note. The connections between Prostate cancers and both Arsenic and Cadmium, for example, may be significant.

What occupations are likely to be exposed to these substances? In some cases, the industry and occupation will be obvious. It may be, however, that too little is known about where these exposures are occurring. It raises questions about the responsibility workers’ compensation and prevention agencies have in alerting industries and occupations of the potential risk to workers. Medical surveillance mechanisms may be needed and perhaps active information initiatives to ensure both prevention and compensation priorities are met.

For more information, I recommend a close review of the links noted above.

What about Pain and Workers' Compensation? (Part 2)

2009-06-01T10:01:00.000-07:00

I know when I injured my foot (acute pain) and when I suffered from recurrent migraines (chronic pain), work was very often out of the question. Even with medications (and sometimes because of them), the mental resources taken up dealing with the pain meant I had little capacity for other activities including work, school and even family.

The reality of pain related to work injuries means that many workers for some time post injury are unable to do anything except deal with their injury. While many workers' compensation insurers will insist they do not compensate for pain, one look at their medical bills they pay will prove otherwise. At WorkSafeBC, I looked at the medications we paid for in 2006 and found seven of the top 20 claims were narcotic analgesics and accounted for 50% of the dispensed drugs paid for on accepted claims.

When pain becomes a chronic part of a permanent disability, workers' compensation legislation, policy and practice have taken varying approaches to 'objectify' pain so it can be compensated.

In British Columbia, the Rehabilitation Services and Claims Manual Volume II
section 39.02 describes two types of 'Chronic Pain':

Specific chronic pain - pain with clear medical causation or reason, such as pain that is associated with a permanent partial or total physical or psychological disability.
Non-specific chronic pain - pain that exists without clear medical causation or reason. Non-specific pain is pain that continues following the recovery of a work injury.

Where a WorkSafeBC determines that a worker is entitled to compensation for chronic pain, an amount equal to 2.5% of total disability may be granted.

California takes a different approach. In case of permanent disability, the worker may be awarded from 0 to 3% of whole person impairment for pain.

In the American Medical Association's Guides to Evaluation of Permanent Impairment, 6th Edition, [AMA Guides, 6th] 'Pain-related Impairment' uses a 15 question questionnaire that generates a point rating based on ten points per question. Those with 70 or fewer points are considered to to have no or mild pain and receive nothing. Those with 71 to 100 points are considered to have moderate pain and receive 1%; Severe (101 to 130 points) get 2% and Extreme 131 to 150) receive 3%.

Deciding on some percentage for impairment due to pain is one thing but how that translates into the real world of work is another. There appears to be no one best way to assess let alone obviate the effects of pain. Many workers' compensation authorities will authorize pain management programs for the most severe cases.

Advances in science, medicine and statistics are likely to improve our measurement of pain and provide more insights into its causes. New techniques and medications will be developed to manage pain. Each advance has the potential to help injured workers but there are likely no simple pathways to a perfect system for assessing and compensating for pain.

What about Pain and Workers’ compensation? (Part 1)

2009-05-25T10:53:00.000-07:00

Pain. We all experience it. It can be mild or debilitating. Sometimes it can be controlled by medication but often, even with medication (or simply because of the medication) activities of daily living are just not possible.

With pain being such a common experience that accompanies injury and many illnesses, I thought I would look at how workers’ compensation systems deal with pain. The first place I looked was at the legislation and I was surprised that most workers’ compensation acts contain no direct reference to pain. Some make reference to “pain and suffering” but only in terms of what workers’ compensation systems will do with third party awards by courts for “pain and suffering”.

Nova Scotia’s Workers’ Compensation Act does make reference to Chornic Pain:

10A In this Act, "chronic pain" means pain
(a) continuing beyond the normal recovery time for the type of personal injury that precipitated, triggered or otherwise predated the pain; or
(b) disproportionate to the type of personal injury that precipitated, triggered or otherwise predated the pain,
and includes chronic pain syndrome, fibromyalgia, myofascial pain syndrome, and all other like or related conditions, but does not include pain supported by significant, objective, physical findings at the site of the injury which indicate that the injury has not healed.

So one Act tells us what Chronic Pain is and what Chronic Pain includes but not what pain is. Without a definition of pain in legislation, I looked to the medical and health profession. The International Classification of Disease (ICD9) has a code series for pain(338) and chronic pain (338.2) as well as chronic pain due to trauma (338.21) and ‘chronic pain syndrome (338.4). Again, that classified it but does not really define pain per se. As far as definitions go, I found many but one for pain and one for Chronic Pain that seem representative:

Pain: An unpleasant sensory and emotional experience associate with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain - IASP)
Chronic Pain: pain that persists six months after an injury and beyond the usual recovery time of a comparable injury; this pain may continue in the presence or absence of demonstrable pathology. (Brock Smith, Report of the Chair of the Chronic Pain Panels [to the Workplace Safety and Insurance Board - WSIB], August 2000)

Most of us can identify with this definition of pain and most are likely to accept the later even without direct experience.

So, pain is real, even if it is not defined in legislation. And it is all too real to those suffering from work-related injury, illness and disease. How do workers’ compensation systems deal with pain? That’s a topic for the next post in this series.

Novel H1N1 Influenza A [swine flu] and Workers' Comp

2009-05-11T09:13:00.000-07:00

The novel Influenza A/H1N1, also called “swine flu”, is in the news and may be a serious threat to human health but what, if anything, does this have to do with workers’ compensation authorities? Any statutory agency concerned with compensation and prevention has at least three aspects of its role to consider.

Like every other employer, it takes people to carry out the tasks and duties of the agency and workers’ compensation organizations have an over-arching responsibility for workplace health and safety. The beginning stages of an outbreak may not be the ideal time to be thinking about that role but it is critical that employers set expectations and communicate, in a timely and clear way, information and expectations to their employees. Questions will arise like “what do I do if I come in contact with someone who likely has the flu?” and “What should I do if a fellow staff member is showing flu-like symptoms?” are bound to arise. If you haven’t thought about these issues in advance, getting a coherent program in place is not only prudent, it is generally your responsibility as an employer. A good example of employee/contractor occupational health communication on this topic is the NASA notice on its website. In their policies discussed in a May 1 teleconference , the following actions were discussed
– “Send home” policies
– Liberal use of telecommuting [for 5 days]
– Self identification following travel to swine flu affected areas

Many workers’ compensation agencies have either a formal or informal prevention mandate. WorkSafeBC, for example, is the regulator, promoter and inspectorate for occupational health and safety in the province. Resources like the web page on Influenza which outlines the employer responsibility and the slideshow/video which provides practical guidance on proper hand washing are great examples of what needs to be done. The specific announcement for healthcare workers and employers regarding respiratory protection is a particularly useful and direct document for those who are among the most likely to be exposed to this biological agent.

Then there are the workers’ compensation claims that may arise. During the early stages of an outbreak, the nexus between the work and the illness may be easily and conclusively shown. Contact with the indentified index case or one of the chain of isolated cases or clusters where that contact arose in the course of and out of the duties related to the job are likely enough for a workers’ compensation claim to be accepted. Quarantine of otherwise healthy individuals may be advisable and even enforced by a health authority but it misses the essential requirements for a workers’ compensation claim.

Once any disease becomes community based and that direct connection between work and the development of disease is lost, the likelihood of a claim for compensation diminishes. The common cold is rarely an acceptable work-related illness because it is, well, common—in the community. The current novel Influenza A/H1N1 is not yet at that stage but there is a chance it could become community based where the risk of contracting the disease is about the same for everyone.

The latest Influenza A/H1N1 may not be the next serious pandemic virus but it already serves as a wakeup call for employers and workers’ compensation authorities to prepare and test plans for a local cluster in the office to a community outbreak or a full blown pandemic.

Thoughts on the IAIABC ACC in Baltimore

2009-05-01T13:50:00.000-07:00

This post is a little behind schedule. I was in Baltimore last week at the IAIABC All Committee Conference and wanted to say something profound about one of the topics covered at that event. We discussed so many things: The impact of recession and recovery on workers’ compensation systems, self-insurance and bankruptcy implications for workers’ compensation regulators, plans for the 2009 convention, and the co-hosting of the 2010 International Forum on Disability Management in LA.

Each of these items could have easily filled a blog post (and might at some point in the future). As I started to write I realized there was a fundamental question being answered by mere fact that such a conference was happening: What is value of attending such multi-jurisdictional events?

In the grips of a recession, the obvious costs were the on the minds of many and prevented some from attending. To be sure, airfare and hotels and conference registrations cost money. Then there are the opportunity costs of having senior policy makers and administrators devoting their time and energies to activities outside their jurisdiction. Over and above these costs are the usual hassles of travel and inconvenience of being separated from family for a week. Despite these costs, powers that be weighed the costs and decided the benefits were of greater importance. Those in attendance at this conference were there because of intentional choices based on the premise: the benefits far outweigh the costs.

So what are the benefits? Conferences like this one provide valuable insight and information of immense value: early warnings, new ideas, feedback on what works and what doesn’t, intelligence on emerging trends and context for understanding developments elsewhere in workers’ compensation and prevention. And beyond the official agenda, the informal discussion and contacts create new networks to support information sharing and understanding.
These benefits have value. Those that attended learned first-hand about the challenges, successes and failures of those dealing with real life workers’ comp issues—lessons that may justify actions worth millions of dollars to a system or prevent the human costs associated with work-related injury, illness and disease. The organizations that chose to send delegates, participate in committee work and contribute to the dialogue obviously get that. And those who get it but are prevented from attending for other reasons contribute in other ways (participation via conference call and discussion forum, for example) and receive at least some of the benefits that way.

Increasingly, policy makers are being asked how their jurisdiction stacks up against others or what the implications of a new law or regulation introduced in another area might be in their own jurisdiction. The price of the ‘free’ information needed to answer those questions is participation in and support of organizations like IAIABC, AASCIF and AWCBC and the committees that are the driving force behind their work—a cost that is well worth the investment.

Why Timeliness of Payment matters in Workers' Compensation

2009-04-15T11:23:00.000-07:00

Timeliness of payment matters. Injured workers and their families have financial commitments for mortgages, tuition, groceries, car payments, and the myriad of expenses we all carry. According to one source, 55 per cent of Canadian workers always or usually live paycheque to paycheque just to make ends meet. Since most families live with small cash reserves, breaks in income continuity due to a work-related injury or illness only add pressure at a time when the injured worker should be focused on recovery.

Recently, the New York Times ran a series of stories on workers’ compensation in the US. One sidebar showed the percentage of claims receiving first payment within 21 days of injury 2004-5. At the ‘best performance’ end of the scale were jurisdictions like Massachusetts, Wisconsin and Texas where about half the claims received first payment within 21 days of injury.

The closest similar statistic for Canada is provided by the Association of Workers’ Compensation Boards of Canada (AWCBC). The timeliness standard is expressed as the ‘Average Calendar Days from Injury to First Payment issued’. While not a perfect parallel to the data quoted in the NY Times, Alberta, BC, and Saskatchewan report averages between 20 and 23 days for 2007.

WorkSafeBC has a target of 17 days average time from injury to first payment issuance. Its current performance is a little higher than that. Put another way, more than half WorkSafeBC’s cases entitled to wage loss benefits are getting their first payments within 17 days of injury.

Several jurisdictions have taken steps to make certain there are no breaks in earnings for injured workers. In BC, many employers (accounting for more than 20% of first payments) continue wage or salary to the injured worker and WorkSafeBC reimburses the employer to the benefit level the worker would be entitled to. In some Australian jurisdictions, employers are responsible for the first week (or two) of benefit before the insurance kicks in.

The point is simply this: timeliness matters. Workers’ compensation involves making tough decisions and tough decisions take time to investigate and consider; knowing that most workers can’t wait more than one pay cycle underscores the need for a ‘sense of urgency’ in the design and administration of workers’ compensation systems.

Why the Oregon Workers’ Compensation Premium Rate Ranking matters

2009-04-06T08:59:00.000-07:00

The 2008 version of the Oregon Workers' Compensation Premium Ranking Study is now posted. It is worth a read even if you don’t do business in Oregon. (A summary is also available).

Without repeating the study, the basic goal is to inform stakeholders as to how Oregon’s workers’ compensation premium rates would compare with those of other jurisdictions. Oregon takes great care to make the comparison realistic and valid for Oregon. Oregon’s researchers select fifty of the most important classifications (representing about 68% of the payroll) and then seek rates from other jurisdictions for the same or similar rating classifications. Finally, Oregon researchers develop a representative index premium based on this data for each state and determine where Oregon ranks on the resulting list.

The Oregon study matters to more than just Oregonians. For any cluster of states with a similar mix to each other, the relative ranking of one state may help identify efficiencies or problems. A ranking among the lower-cost jurisdictions not only means a lower cost for employers, it may also reflect a lower cost of injuries to workers. Since severity and frequency are major cost drivers, changes in ranking (particularly in states with similar benefit structures and practices) may reflect changes (or differences) in the prevention environment as well.

It is important to note the following about the Oregon premium rate study:

The selection of classifications is based on what is important in Oregon.
Classifications are based (primarily) on NCCI definitions.

The weightings used to develop the rates are based on Oregon payrolls (although the major classes are usually within the scope of coverage in all jurisdictions-- clerical, sales, education, medical offices, restaurants, retail stores, hospital, auto repair, trucking)

Expense loading factors, or loss cost multipliers are accounted for.

The study result is an ordered ranking of index premiums. The median index premium rate is $2.26 per $100. Oregon, ranks 39th on the list of 51 included in the study with an index premium rate is $1.98 per $100 (83% of the median rate).

This is important information particularly for those in Oregon but remember it is Oregon’s rate ranking using Oregon payroll weights. If a jurisdiction has a similar industry and payroll mix to Oregon, the study may provide general guidance on the competitiveness of rates; if a jurisdiction has a very different mix, the comparability is likely of less value. Washington state’s ranking on the same list is 38th at $1.98 but this is based on Oregon’s weights, not Washington’s. Although one might assume some reasonable comparability between Washington and Oregon, it is conceivable that Washington could actually have a lower ranking (less costly premium) if Washington’s weights were used in the comparison.

The study does not include jurisdictions outside the US. British Columbia publishes rates [see WorkSafeBC.com] and it is possible, therefore, to generate a similar ranking based on Oregon weights. Such an exercise would show BC with rates near the lowest in the Oregon ranking. Since rates are based on a percentage of payroll, changing exchange rates are not a factor in the comparison. Put another way, if Oregon had WorkSafeBC’s premium rates for the industries and payroll weights used in this study, the result would be an index premium at the bottom of the current list.

Why would BC rank so much lower than Oregon on this scale? It may have something to do with the nature of the classification system. BC’s assessment rates are more industry based than NCCI classifications (which are more occupationally based). Lower health care costs in Canada may be a factor. Lower administrative costs, effective case management and vocational rehabilitation/ Return to Work initiatives, effective prevention initiatives, economies of scope and scale, and [perhaps] lower costs for disputes may all play a role in lower premium costs (assuming similar benefits and practices).

The bottom line is that BC, Washington and Oregon would have relatively low index rates if directly compared using the Oregon methodology, a result that benefits the economies of all three jurisdictions.

What's worrying workers' comp insurers: Part II

2009-03-26T14:45:00.000-07:00

As part of my international scan of top issues worrying occupational safety/health and workers' compensation authorities, I've been listing the top issues clusters. In this post, I am continuing that list to round off the top dozen areas of concern.

6. Hearing, Noise and Ototoxins: This cluster is about the impact of work-related factors on hearing. Several sources noted increases in hearing-related claims and in the emerging science of substances and other agents in the workplace that may contribute to hearing loss. This area has implications for both prevention and compensation policy.

7. Pandemic, New Pests and Diseases, Zonotic vectors, Infections and Parasites: Changes in climate and travel as well as antibiotic-resistance are captured in this cluster. There is growing concern over the impact these factors could have in the workplace. Prevention strategies are stressed but contingency planning is advised. Several insurers also raised the issue of how they and their prevention counterparts would operate in conditions of an outbreak (would staff even come to work) so business continuity planning is also advised.

8. Respiratory and dermatological issues: Asthma is a growing concern and endotoxins [causing fever, acute toxic effects, allergies, organic dust toxic syndrome (ODTS), chronic bronchitis, and asthma-like syndromes, or lead to lethal effects such as septic shock, organ failure and death] are noted and forecasted to increase by several authorities particularly in Europe. With the growing population of asthmatics among youth, the potential for exacerbation of pre-existing conditions are increasingly likely as young workers enter and become the future workforce. Work environments that were not a problem for most workers a decade ago may pose a serious health threat a decade hence.

9. Foreign workers: Legal or not, short or long term, skilled or not--the numbers of foreign workers are increasing in Europe, Canada, the US and Australia. Language and culture are only two of the many barriers that may inhibit prevention and may account for a lower than expected access to workers' compensation. Reaching this audience, providing education and access will vary by vulnerability of the population but will almost always take greater effort than for similar citizen and legal permanent resident populations.

10. Musculo-skeletal injuries (MSI): This cluster was raised by several sources. Linked to the obesity issue, demographics, and changing work systems (involving greater repetitive actions) these injuries are and will continue to lead the list of work-related injuries. Ergonomic regulation may be part of the answer but new approaches to MSI are needed.

11. Terrorism: Chemical, biological, radiological, nuclear threats may be directed at more than workers but workers are likely to be injured in any terrorist attack and its aftermath. Workers were injured and killed while in the course of their employment in several terrorist attacks. Whether domestic or foreign perpetrated, workers and their families will suffer. What worries insurers is just how wide and deep the impact might be.

12. Cancer (emerging work-related causes and under-reporting of): As you saw in my previous posts, cancer is likely work-related to an extent far greater than recognized. That IARC study I cited [in my post from January], shift work was implicated as a probable human carcinogen. A few weeks ago, Denmark accepted 40 claims for breast cancer from flight attendants and nurses with long histories of shifts that interfered with circadian rhythms. [See this BBC story for a good lay overview].

There were other issues: human performance enhancement, synthetic biology, work relationships, fatigue/human factors to name a few. This list of issues may signal areas workers' compensation and prevention authorities ought to be looking at more closely--not simply because of the dollar costs implications--but because prevention can actually make a difference in protecting workers. It is the right thing to do.