An Environmental Scan for Workers’ Compensation - 2023

Environmental Scanning is a critical exercise for workers’ compensation and other personal injury insurers.  Identifying developments, trends and projections in the operating environment help policy makers prepare for and adapt to the threats and opportunities.  Here is a thumbnail environmental scan to stimulate thinking about the emerging challenges for workers’ compensation (and personal injury insurers) from five perspectives.

Social/Societal Challenges:

Workers’ compensation is a form of social insurance; changes in society from its structure to its norms create challenges.  I’ve noted many societal changes in past blogs but here are four challenges that should be in every scan:

1.        Demographic change.  The structure of our national populations is changing.  The causes are diverse:  refugee population displacements caused by civil conflict, natural disaster, climate change and economic crisis; the decline in the proportion of labour-forced age population in Canada, the US and Australia; and the rise in the number of older workers.  Workers’ compensation organizations (WCOs) can’t alter these impacts but have to adapt to the consequences of these changes: Older workers getting injured, greater co-morbidities, increases in complication and recover times, poor health, limited personal resources, language and culture differences among those new to the jurisdiction, etc. 
2.        Mental Health.  Greater recognition and acceptance of mental health is both a challenge and an opportunity for WCOs.  On the challenge side is finally accepting that mental injuries can arise directly from work or can be exacerbated by work.  Adjusting policies to reflect this recognition is not trivial.  On the policy side, there is wide variation in the standard of proof and onus of proof required to establish a mental injury.   Costs that flow from treatment and compensation can be huge.  The opportunity for prevention, fostering acceptance, building resilience, and supporting return-to-work/ stay-at-work strategies must be developed.  That takes commitments in terms of time and resources outside the typically meager research investments and general prevention awareness campaigns.
3.        The changing nature of work itself.  The Gig economy, remote work, and hybrid employment are among the challenges that change our concept of employment.  Are gig workers employees or contractors? What workplace protections and compensation ought they be entitled to? Where is the workplace for a remote worker (and is their payroll assessable out of jurisdiction)? What rules apply to multi-job holders or extra-national employees?  Are the wages of workers living just across the jurisdictional boundary to be included in payroll estimates?  Are workers in the course of employment when travelling from their home office where they work remotely to the corporate workplace or in-person meeting?  These are not just questions for each jurisdiction to decide; interjurisdictional agreement and consistency may be required to minimize gaps and overlaps in coverage.
4.        Amplification in social media/Rising distrust:  I’ve often said one bad workers’ compensation story (true or not) repeated a hundred times creates as many bad impressions as a hundred individual stories, each reported once.  Social media allows and even rewards negative stories that create outrage and can rapidly erode the social capital of WCOs and personal injury insurers more broadly.  Arguably, this phenomenon is not limited to workers’ compensation.  Trust in government has declined in many jurisdiction [see OECD, “Building Trust to Reinforce Democracy: Key Findings from the 2021 OECD Survey on Drivers of Trust in Public Institutions”,   https://www.oecd.org/governance/trust-in-government/ ],amplification has eroded trust in authorities, politicians, and insurers generally.  Countering this trend isn’t easy particularly because of privacy and confidentiality rules that create an asymmetry between what can be said in social media and released corporately.

Environmental Challenges:

WCOs and occupational safety and health professionals often ignore climate change and its consequences as a risk to their own operations.  Weather extremes such as prolonged winter storms, lengthy heat domes, and persistent atmospheric rivers are becoming more frequent and linked to climate change and are increasing [see .US EPA, “Climate Change Indicators: Weather and Climate”  https://www.epa.gov/climate-indicators/weather-climate for examples]. Often ignored are the follow-on impacts including changes in the distribution and risk of viral and bacterial diseases, changes in intensity and duration of fire seasons, and degradation of air quality.   Some things to focus planning on include:

1.         Hardening infrastructure:  you can’t operate if your systems are vulnerable to environmental issues.  The once in a hundred-year flood, power outages that last a week and heat events that overwhelm data centres can crash all an organization’s ability to serve its customers and protect its resources and reputation.
2.        Preparing workers and employers:  It is fine to say you have to have a plan but few organizations actually prepare for and test plans for events and conditions in this domain.  As the Covid-19 pandemic revealed, acquiring protective gear and educating populations at the last minute is not a plan.
3.           Changes in the frequency and severity of resulting claims:  Just-in-time information does have a place.  Warnings about shade and hydration in advance of a heat event can limit work injuries and disabilities.  Anticipating the changing road conditions in advance of floods or fires is an opportunity to mitigate claims risk. When surges in claim activity occur, the ubiquitous “We are expecting higher than anticipated volume…” will not only further harm the victims but also diminish any reservoir of social capital built through other actions.
4.       New jobs, new risks: Changing sector size:  Environmental change has consequences for the types of businesses requiring workers’ compensation coverage, regulation and prevention initiatives. Wind generation towers off shore, increased solar installations and unique conservation methods involve new jobs and innovative technologies with different risks than the traditional job set.  Regulation of materials and mandated recycling can add to the challenges and change the safety and health risks of existing jobs.  Whole sectors may fade  or expand due to climate change (hard to have a ski season if there is no snow). Impacts are not only on policy holders and those injured but also on the organizations that service them.  Changes to rate groups and risk categories can disrupt funding models.   

 Political/Regulatory Challenges

Workers’ compensation (and other personal injury insurers) are subject to regulation.  The degree of regulation and the extent of its swings is a political matter.  The level of regulation, prescribed coverage mandates, and levels of benefit may all become the subject of political debate or regulatory reform.  Often driven by public sentiment around the need for change, several trends are emerging.

1. Increased cost containment initiatives:  Fee schedules are being mandated and adjusted in several jurisdictions.  Drug formulary introduction and expansion is another emerging trend.  These generally favourable to cost control but can increase friction and monitoring costs, particularly in a time of high medical cost inflation and rapid change in pharmacological science.  Conflicts are likely at the margins, and this can quickly escalate and result in poorer outcomes and degradation of public confidence in the system.
2. Mental health:  The growing acceptance of mental injury as note above is making it into legislation with amendments to health and safety laws, expansion of coverage for PTSD and other mental injuries for certain classes of workers (often, first responders).
3. Presumptions:  Faced with the difficulty of proving causation to the legislative requirement, the use of presumptions is becoming more common.  We see Covid-19 being added to the list of presumptions for workers’ compensation in some jurisdiction for certain front-line workers.  While often rebuttable (or inoperative once community spread exceeds a certain level in the case of Covid-19), the pressure to expand presumptions is evident.  
4. Changes in Eligibility Requirements/ Expansion of coverage:  Generally, the long-term trend to increasing the scope of who is covered in workers’ compensation and what is covered (nature of injury or disease, treatments accepted, reduction or elimination of waiting periods, and level of benefits) have been on the rise.  Even where there is no change, the actions in other jurisdictions are often widely reported and frequently raised for consideration in other jurisdictions.  Monitoring, tracking, and developing positions need to be an expanded part of ongoing corporate planning for WCOs and personal injury insurers.

 

Economic Challenges:

 The Great Financial Crisis, Covid-19, the war in Ukraine… it seems the interconnected economic life of the planet is suffering a new calamity every few years.  For insurers in the work disability space where claim liabilities are incurred then paid out over what can be extended times, these cyclical hits to the economy can upend assumptions.  Reserve policies, asset allocation and growth assumptions may all need revisiting.  Here are some economic perspectives deserving particular attention. 

1.  Medical cost inflation:  According to recent Milliman study (https://www.milliman.com/en/insight/medical-inflation-drivers-and-patterns), medical inflation tends to outpace general inflation over time.  To the extent that medical costs are part of the cost of work and personal injury claims, this pattern can have a big impact on overall claim costs.  The most recent NASI study pegs medical costs at about 47% of workers’ compensation benefit costs based on 2020 claim data.  That’s down from its pea at over 50% in 2014 (see https://www.nasi.org/research/workers-compensation/workers-compensation-benefits-costs-and-coverage/). With aging populations, healthcare professional shortages and increasing drug costs, this perspective deserves attention.
2. Inflation, investment, and interest rate volatility:  WCOs face administration cost increases due to inflation including the upward pressure on wages, facilities and energy.  Not all systems offer cost-of-living protection for beneficiaries but those that do are facing significantly larger increases than the 2%-3% assumptions that may have been in place.   Where such protection is not in place, the political pressure to increase benefits will be significant.  The cost and return assumptions to cover the  “long tail” of claims costs in personal injury claims are highly susceptible to economic assumptions.  Serious and continuous monitoring of assumed inflation costs, discount rates and reserve levels are critical.
3. Policy-holder disruptions:  The book of policy holders remains relatively constant from year to year, at least that was true in the past.  Economic pressures including supply chain issues, inflationary pressure, and labour shortages are causing more business to shutter.  Bankruptcies and insolvency rates are rising.  Other disruptions (including technological innovations) are drastically altering the business landscape.  The resulting shifts can upset risk models and the credibility of rate groups, the basis for rate setting. 
4. Stakeholder financial education:  Insurance financing is a mystery to most people.  Personal injury insurance including workers’ compensation requires complex financial considerations.  Overcoming the “math is hard” mindset is a necessary if difficult task.  Insurers must be transparent about their financial position but have a responsibility to communicate that simply and effectively to wider audiences.  Beyond timely annual financial statements, employers need to understand how their premiums are established and the consequences of their performance.  Unfunded liabilities, unjustified reserve levels or over-funded positions need to be explained and understood if systems are to be sustainable.

 

 

Technological Challenges:

 

WCOs are big users of technology.  Increasingly, automation is taking over the routine claims administration.  Actuarial, finance and statistics roles are all heavily reliant on technology.  The benefits and vulnerabilities of that reliance are changing at an accelerating rate with big implications for WCOs.  Advances in medical technology that may impact the cost of claim, telemedicine can speed access to care, wearable technologies can improve protection for individual workers, and artificial intelligence can assume a greater role in claims processing, freeing resources for more direct care and attention.  On the prevention front, new tech will better protect workers, although the potential for over-reliance on systems and latent errors will undoubtedly occur. Those are all positives to be included in any environmental scan, but there are potential negatives to be considered. 

1. Cybercrime/Security:  Denial of service attacks may have declined but ransomware and data breaches have exploded.  Securing personal data, health records and financial transactions is critical.  Testing and probing exercises have to be stepped up and active monitoring of breaches elsewhere is critical.  What lessons are we learning from the Chubb, Axa and CNA Financial attacks?  
2. Artificial Intelligence:  As these tools emerge and are integrated into claims processes, they will also be used to design new ways to exploit weaknesses in security, claims processes and even appeal processes.  Already Zurich insurance is using an AI robot to process claims in seconds [ See Jacob Maslow,  “How Automation Will Change the Business of Personal Injury”, LegalScoops.com, 21 Feb 2021, https://www.legalscoops.com/how-automation-will-change-the-business-of-personal-injury/ ].  Many aspects of insurance from underwriting, to adjudication, claims management, and even appeals are already benefiting from machine learning. [See Eray Eliaçık,  “The insurance of insurers”, Dataconomy.com, 22 September 2022 https://dataconomy.com/2022/09/artificial-intelligence-in-insurance]. One additional note under this heading.  Public facing AI programs are fledgling and sometimes very inaccurate or misleading on specifics in workers’ compensation law, policy and benefit parameters.  This can contribute to inappropriate conclusions causing some to question decisions or avoid filing claims that would otherwise be advisable. 
3. Quantum computing:  The promise of quantum computing includes security but getting there will take time and a lot of resources.  My fear is that many will put off recognizing this until it is too late. All that security and protective procedures you have in place may become vulnerable soon than later.  A recent SwissRe report identifies this emerging risk with examples that could include internal failures and delays, external direct threats to security and indirect threats such as supplier, partner or infrastructure failures that could arise because of the threat.  [See  Maren Bodenschatz et al, SONAR 2022: New emerging risk insights – 10th anniversary edition, 16 June 2022, https://www.swissre.com/institute/research/sonar/sonar2022.html] 
4. Medical diagnosis and treatment:  Advances here hold great promise.  We will be able to link more cancers to their work or environmental causes; new treatment will emerge to battle the multitude of disease; Immunological and genetic treatments will extend life and health.  For insurers, these will add significant costs, at least initially.  As new treatment modalities arise for physical injury and disability, demand for access to them will accelerate.  Exoskeletons for paraplegia, neuron transplants to reverse paralysis and restore degrees of function, implants that replace organs, regulate body systems, and even enhance functionality will become standard treatment, potentially contributing to increased medical costs. 

Environmental scans are starting points for discussion and consideration.  Your list of examples will likely differ from mine but there will likely be common themes.  It is too easy to put off discussion of issues from these perspectives.   Doing so only increases the potential risks and diminishes potential opportunities to preserve and improve workers’ compensation protections for workers, employers and all of us who benefit from well run systems that are as prepared as they can be for what is coming next. 

How do we make Workers’ Compensation organizations better?

 

The pandemic disrupted the operations and planning of many workers’ compensation organizations (WCO).  Researching and planning had to shift from strategic initiatives to tactical priorities of protecting staff and serving the workers and employers reliant on workers’ compensation.  As we transition to the post-pandemic era, planning for the longer term must gain in priority. 

The international consulting firm, Deloitte, published a study on the future of workers’ compensation organizations in 2020, just as the COVID-19 crisis was impacting services across the sector.  The timing of its release meant that many policy makers, boards of directors, and planners may have missed the analysis.  A link to the study at the end of this post.

The study is based on surveys of 18 workers compensation organizations in the US, Canada, and Australia.  It identifies five “levers” that workers’ compensation organization can use to shape the future of service delivery and outcomes.  The five levers are:

• Risk-based segmentation
• Standardized plans
• Case management team structures
• Focus on prevention
• Leveraging behavioural economics

The study focuses the work and structure of WCOs on return to work (RTW) and recovery.   For many WCOs, this means a functional shift from internal processes focus of claims inventory management to better outcomes for workers in terms of health, safety, recover, and RTW. 

Risk-based Segmentation:

The majority of workplace injuries result in little or no time away from work.  Workers are often back on the job before a claim is fully established.  Identifying these cases as low risk in terms of difficulty in recovery, rehabilitation and return-to-work can streamline operations, improve customer service and focus resources where they are most needed. 

Many organizations are adopting “auto-adjudication” methods for more routine cases.  What is often missing from the system is segmentation based on the risk of failing to return to work or the difficulty of returning to work.  The study suggests that up to 80% of cases may be handled fully or mostly by automated systems.  This meets service expectations of injured workers wanting timely decision-making and payment of claims.  It also frees resources to focus on more complex cases including, shoulder, back, traumatic stress, occupational cancers, and fatalities. This is not just Pareto principle, example, but a practical imperative.

Organizations that stream or triage cases into specialty areas from the start of the claim are already well on their way towards fully risk-based segmentation.  I have seen specialty units set up for hand injuries where treatments are arranged and commenced before the claim is fully adjudicated and accepted.  Some agencies have experimented with sensitive and mental injury claims groups to adjudicate and case manage injuries related to harassment, assault and stress—claims with a high risk of lengthy recovery, recurrent disability, and difficulty in sustained, safe return to work.  Risk-based segmentation has the potential to make workers’ compensation organizations more efficient and better at optimizing worker outcomes.

Standardized plans:

The Deloitte study emphasizes the use of standardized plans.  This strategy follows from segmentation and takes different forms in different workers’ compensation organizations.  Case managers, treating physicians, and therapists can use standardized treatment, rehabilitation and recovery protocols as the basis for planning, setting expectation, and more quickly identifying cases issues that may jeopardize outcomes. 

Standardized treatment plans are not cookie cutters but starting points for taking those medium and higher complexity cases toward the objective of RTW and recovery.  These are not the old medical yardstick tools of the past.  Treatment and rehabilitation guidelines (See as an example, WorkSafeBC, Ankle Ligament Reconstruction Post-op Rehabilitation Guidelines,  available at https://www.worksafebc.com/en/resources/health-care-providers/guides/ankle-ligament-reconstruction ) provide the worker, case manager, and treating professionals with common understanding, expectations,  and roadmaps to RTW and recovery.  This standardization does not obviate the need for customization and active case management but does lead to consistent treatment, fewer delays and ultimately better outcomes.   Besides the transparency and predictability standardized plans offer, they also allow greater time for providing support to workers and their families.

Case management team structures

Having effectively and accurately segmented cases and standardized plans, WCO structures and systems need to be aligned to manage cases.  Injured workers with medium to high complexity injuries complain about case manager lack of understanding of their injury, constant hand-offs, and “churn” in personnel.  Injured workers often ask me, “Should it be up to me to training my case manager?” and “Why do I get someone new every time I call?.  They hear about a “team” approach but are never told what that means.  Rarely is the team members identified by name and responsibility.   

It is not just about structure.  It is about training and specialization that can implement the best practices of RTW consistently.  Mental health teams, for example, can be very effective if the teams have the deep understanding that comes with training and experience, often within a specific sector (particularly law enforcement, paramedical services, and healthcare).

Structures need foundations.  The infrastructure to support case management in the future WCO will not be the same as it was in the past.  Analytics and artificial intelligence will facilitate timely actions and flag cases where interventions are necessary.  This is not just about following schedules but integrating information to overcome barriers to RTW or impediments to recovery so they can be acted upon in a timely way.  Ontario’s WSIB, for example, offers the following “Specialty Programs” to:

…provide timely access to expert specialists for people with work-related injuries or illnesses. These programs specialize in recovery and achieving a healthy and safe return to work by conducting an assessment and providing interdisciplinary treatment for more complex injuries and illnesses.

(see WSIB, Specialty Programs, available at https://www.wsib.ca/en/specialtyprograms)

 

Focus on prevention!

Some seek to limit the concept of “prevention” of injury but a more inclusive definition that embraces the prevention of disability is needed.  This is not as clear in the Deloitte study as it should be.  While there is a nod to changes in terminology away from “injury management”  to language and practices consistent with recovery and return to work.

As the Deloitte study points out, the prevention mandate varies widely across WCOs.  About half the Canadian jurisdictions and a few jurisdictions in the US and Australia, the legislative mandate for  occupational health and safety including prevention is embodied in the workers’ compensation legislation or authority.   

Regardless of mandate, the study asserts,  “prevention efforts can support all WCOs in realizing sustained reductions in claims volumes and costs, higher safety literacy rates, and communal ownership of prevention.”  [p.15] 

WCOs can act directly within their mandates.  According to the survey, WCOs are now leveraging a focus on prevention to reduce injuries and prevent through”

• Periodic workplace safety audits are conducted (50%)
• Employer rating/pricing is tied into their implementation of health and safety programs (56%)
• Work with employers to create customized safety programs for them (61%)
• Employers are offered a menu of safety programs that they may implement and adopt as needed (61%)

The Deloitte study flags strategies that focus on cultural change within the workforce, third party collaborations to enable safety and prevention in the workplace and data analytics to support workers and employers in preventing injuries before they occur.  A prime strategy is to focus on industry and partner with employers, industry groups and labour organizations.  Dedicated departments focused on prevention initiatives with the personnel and budgets to initiate, sustain and expand preventions efforts are essential.

Examples such as the collaborative cultural change efforts include

• The Community Against Preventable Injuries in BC  https://www.preventable.ca/join-the-community/,
• WorkWell initiatives in Victoria, Australia,  https://www.worksafe.vic.gov.au/workwell and
• Premium Pricing features in Alberta https://www.wcb.ab.ca/assets/pdfs/employers/pricing_2023.pdfb .

Collaborative initiatives targeting segments of high risk, high complexity at their route are essential to effectiveness of this lever.  WCOs through collaborations and initiatives can bring predictive analytics, the latest research, retrospective data analysis and resources to bear on issues to prevent injury and disability as with  BC First Responders’ Mental Health (see http://conference.bcfirstrespondersmentalhealth.com/).

 

Leveraging behavioural economics

WCOs are learning to reach beyond the traditional disciplines of insurance and enforcement in finding ways to achieve a future state.  The Deloitte study highlights the power and potential of behaviour economics to better understand and influence the way people behave.  

WCOs have employer performance data on injuries, fatalities, inspections, and penalties that are too often hidden from the public, workers, and other employers. Overcoming the organizational inertia or limits of the WCO mandate is essential to bringing about this future state.

One of the  “future” behavioural economic approaches highlighted include publishing employer injury rates online.  A great example of this already exists in Alberta.  With the entry of an employer name, results covering up to five years of data are instantly available.  The data are rich and include person year estimates, disabling injuries, lost-time claims, workplace incident fatalities, occupational disease fatalities and much more.  Injury rates for the firm and the overall industry add to the context.  The database includes summaries of occupational health and safety orders, administrative penalties, and even convictions.  [See https://extern.labour.alberta.ca/ohs-employer-search/occupational-health-safety/employer-records-search.asp] .

The study also highlights research out of New South Wales that used behavioural economics:   

…to personalize support for workers and encourage them to actively participate in the recovery process. Practices included reducing the volume and detail of communications, reframing messaging to focus on recovery and RTW rather than on injuries, and having case managers provide more personalized support that was targeted to workers as individuals. [p 18]

 

 Closing comments

For corporate planners in WCOs, the Deloitte study is a must read.  It is not about the distant future but an emerging one where the ideas presented are actual, real world actions underway that have the potential to further prevent injuries and achieve better outcomes for workers and their families. 

The study “The future of workers’ compensation - How workers’ compensation organizations are improving return-to-work outcomes” is available at:  https://www2.deloitte.com/ca/en/pages/financial-services/articles/the-future-of-workers-compensation.html

Workers’ Compensation Premium Rates: How does your jurisdiction compare?

Comparing system features and worker outcomes in workers’ compensation is an attractive concept.  Theoretically, the existence of credible, authoritative analytics measuring comparable data across jurisdictions can lead to improvements over time.  Knowing where your workers’ compensation ranks in terms of costs, benefits and outcomes is essential to any benchmarking exercise.  Comparative studies provide stakeholders with context in assessing system performance and policy makers with objective data for decision making. 

Unfortunately, comparative studies of workers’ compensation system features and outcomes are rare.  As with all forms of measurement, comparative analysis is costly and time consuming.  Beyond the challenges of designing a rigorous methodology, getting jurisdictions to provide data for comparison can be daunting. Not every jurisdiction is willing to invest the time and effort to respond to data requests.  Others have restrictions on sharing data.  Still others simply do not see the value (or don’t really want to know the results) of comparative measures and analytics. 

A great example of a well-done interjurisdictional comparison come from Oregon. 

Oregon Workers’ Compensation Premium Rate Ranking Calendar Year 2022

Link:  https://www.oregon.gov/dcbs/reports/Documents/general/prem-rpt/22-2083.pdf

The latest in this biennial series carries on with a rigorous methodology that produces a ranked list of employer premium costs across all US states using Oregon’s “mix” of industries.  The time series of results provides policy makers and consumers with objective data on a key factor of workers’ compensation. 

The study’s ranking is valid for Oregon and relevant for any state asking, “If we had Oregon’s mix of industries, what would our average premium rate be?”  Knowing Oregon ranks in the lowest third in terms of premium index rate (normalized for Oregon’s mix of industries) is important and relevant to Oregonian policy makers and stakeholders. 

The study’s headline findings are clear:  Oregon’s index compensation rate is just $0.93 per $100 of payroll, well below the national average of $1.27.  Oregon ranks 42 of 51—among the lowest cost jurisdictions in the US. 

States with a similar industrial mix might reasonably interpret their state’s ranking directly from the study.  The more relevant question for any other state can only be answered from applying their own mix of industries in an equivalent analysis.  That is not directly knowable from the study.  I know that a few jurisdictions have tried to do this (WorkSafeBC did so for a couple of years).  From personal experience, I can attest to the challenges of getting even a small number of comparator jurisdictions to contribute their data to similar analysis. 

The study has applied a consistent methodology over time.  The study is repeated ever two years. This provides a further dimension to the ranking. Because the Oregon rate ranking uses consistent measurements over time, its results allow decision makers and stakeholders to see trends and ask important questions.  Knowing how you compare answers one question; deciding whether your ranking is where you want it to be or the underlying drivers that result in the rank order observed raise many more questions.

Every study has limitations.  Oregon study provides cost data in terms of an index premium ranking but does not contain “benefit” data—the compensation and medical expenses covered by workers’ compensation insurance.  The Oregon study does not provide the benefit context or total costs—that is not the study’s purpose.  Its focus is narrow: premium rates—not the underlying drivers.  The premium must cover benefits (and other costs including administration, underwriting expenses, and profits).  Few states offer identical benefits; compensation rates vary; most states have waiting periods but even these vary in length and conditions (if any) for retroactively funding waiting periods; even the maximum earnings that are insured by workers’ compensation vary widely.  Medical costs also vary widely.  All of these can influence benefit costs.  Jurisdictions with higher benefit costs may have higher premiums. 

Great data, normalized to your jurisdiction is wonderful information, but it is just a starting point.  The rigor and completeness of the study provides the basis for assessing status and discussing future direction.  Policy makers can examine how changes in premium rates (perhaps to fund improvements in benefits) might impact ranking.  Stakeholders can not only discuss where Oregon ranks but engage in debate on the appropriateness of that ranking or the likely changes to Oregon’s rank if certain policy changes were adopted.  The Oregon study tells Oregonians where their premium ranks; only Oregonians can decide on where they want to rank or even if ranking should be considered in their decision making. 

Why don’t more jurisdictions do this sort of study?  Over the years, I’ve heard a variety of reasons and can infer a few of my own.  The top reasons for NOT doing comparative studies:

• Hard to do well and damaging if done poorly
• Costly in terms of time and resources
• Challenging in getting comparators to participate
• Difficult to standardize measures across jurisdictions
• Possible misinterpretation of results
• Results are almost always lag real time performance
• (Not really wanting to know or fearing the eventual results)

 

If you really do want to know how your workers’ compensation system ranks in terms of premium costs (or any other measure), are willing to invest the time and effort into designing the study; can get your comparators to participate by providing their own measurements, then the H. James  Harrington quote is still relevant:

Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it

[The Improvement Process: How America's Leading Companies Improve Quality, 1987]

If understanding, control, and improvement are your goals, then the Oregon approach is a great model to emulate. 

International Students and work-hazard exposure: Are we managing their risks?

Recent changes in Canada and Australia allow international students to increase the hours they work outside their studies. 

Previously, international students in Canada were permitted to work only 20 hours per week outside their school programs; that limit has been temporarily removed until December 31, 2023.  Australia moved earlier and lifted a similar cap until June 30, 2023.  In the US, an on-campus 20-hour restriction exists during sessions with additional hours during breaks and specific exceptions for certain groups and circumstances. Demand for workers means more students working more hours in more sectors in the economy.

Clearly, the easing of restrictions on work hours is intended to alleviate labour shortages, particularly in the service sector.  That said, many students work in many other sectors of the economy.  In my own experience, I have met international students working in construction, manufacturing, transportation, warehousing, and healthcare.

Increased Hours = Increased Risk

With unlimited hours on top of studies and on-campus work (often part of their studies), international students are exposed to more hazards.  Recall that risk is the chance or probability of harm from a work-related hazard.  That increased risk is greater than you might expect.

First, the risk of injury and occupational disease is related to exposure.  For most jobs, one can think of exposure in terms of hours exposed to the hazards present in the workplace.  Increased hours alone account for increased risk in the population of international students who engage in employment.  Holding the number of international students constant and increasing their exposure to work hazards through increased hours, increases the likelihood of occupational injury and disease.

Fatigue and Risk

A second factor can increase the risk beyond a straight linear relationship.  The fatigue – risk relationship is an accepted fact.  NIOSH-CDD writes:

Fatigue can slow down reaction times. Reduce attention or concentration, limit short-term memory and impair judgement…High levels of fatigue can affect any worker in any occupation or industry with serious consequences for worker safety and health. 

[See https://www.cdc.gov/niosh/topics/fatigue/default.html ]

Published studies rarely focus on non-work sources of fatigue outside of commuting time and breaks between shifts.  Study time, family needs and other factors can add to fatigue and increase risk.  Some industries have modeled hazards and fatigue related risks [for example, see Transport Canada, Fatigue Risk Management System for the Canadian Aviation Industry - Introduction to Fatigue Audit Tools - TP 14577 available at https://tc.canada.ca/en/aviation/publications/fatigue-risk-management-system-canadian-aviation-industry-introduction-fatigue-audit-tools-tp-14577 ]

Models and studies of enhanced risk facing resident and foreign students are lacking but the implication of existing knowledge is that the added hours of exposure to potential harms may disproportionately increase risk of injury or disease.

International Student Population

The population of foreign students is not trivial. Australia, Canada, and the US are three of the top five destination countries for foreign international students, accounting for more than 2 million of the estimated 5.6 million international students world wide. 

Rank	Country	International student population (2020)
1	USA	1,075,496
2	UK	551,495
3	Canada	503,270
4	China	492,185
5	Australia	463,643
		3,086,089

 

[see https://studee.com/guides/10-most-popular-countries-for-international-students/ ]

These are significant numbers.  Policy changes expanding hours increase the potential labour supply of this population’s in terms of allowed work opportunities may be needed to address demand for labour in the economy.  Current labour market shortages are evident in many jurisdictions.  Along with inflation, rental housing shortages and increased costs for transportation and study materials (particularly technology), international students may have a greater motivation to take advantage of greater opportunities for employment. 

Stock, Flow and Foreign Student Population Measures

International students pose a challenge for those charged with designing health, safety and workers’ compensation awareness programs for them.  At any given time, the population of international students can vary.  Most courses of study span a calendar year or more.  Study visas may be valid for or across multiple years, but students may enter and leave the jurisdiction as part of their studies or simply to return home for part of any given year. This is the “flow” of international students.

Unlike refugees and new immigrants (definitionally,  permanent or extended-stay residents including asylum seekers) or temporary foreign workers (individuals contracted for periods of greater than a year or returning on a seasonal basis), foreign students are generally in the jurisdiction for shorter periods (not permanently).  At any given time, the population or “stock” of foreign students may exceed the “flow” or count of new arrivals. 

Once a cohort of new immigrants or temporary foreign workers is oriented to health and safety or workers’ compensation in the jurisdiction, they are often considered part of the resident population in terms of knowledge and awareness programs.  With foreign students, the “stock” is ever changing and the challenge of raising awareness, building trust, and informing them of their rights and obligations never wains.

Experience and expectations

Workplace culture is not universal.  Attitudes and beliefs regarding workplace health and safety vary widely.  Experiences and understandings about workplace health and safety and workers’ compensation also vary by country.  It is not reasonable to assume all international students bring the same understanding to the workplace.

Consider the following: 

Canada's top 10 international student source countries (by number of study permit holders on Dec. 31, 2021)
India	217,410
China	105,265
France	26,630
Iran	16,900
Vietnam	16,285
South Korea	15,805
Philippines	15,545
United States	14,325
Nigeria	13,745
Mexico	11,550

[ See https://www.cicnews.com/2022/03/canada-welcomed-450000-new-international-students-in-2021-an-all-time-record-0323762.html#gs.fl1tae ]

 

 

US: Number of international students studying in the US in 2020/21, by country of origin
China	317,299
India	167,582
South Korea	39,491
Canada	25,143
Saudi Arabia	21,933
Vietnam	21,631
Taiwan	19,673
Brazil	14,000
Mexico	12,986
Nigeria	12,860

https://www.statista.com/statistics/233880/international-students-in-the-us-by-country-of-origin/

Australia: Number of international students studying Australian courses January-July 2022
China	141,567
India	86,782
Nepal	51,579
Vietnam	19,932
Indonesia	14,865
Malaysia	14,135
Thailand	14,015
Brazil	13,963
Philippines	13,703
Colombia	13,661

 [ See https://www.education.gov.au/international-education-data-and-research/international-student-numbers-country-state-and-territory ]

With the possible exception of international students from Canada, the US and Australia studying away from home in one of the other countries in this grouping, foreign students will have no prior understanding of the jurisdictional authorities responsible for workplace health, safety and workers’ compensation. I could find no study contrasting the a priori understanding of international students regarding workplace laws, duties, and responsibilities.  While resident citizens will have some understanding from their indirect exposure through media, family, and community, it is unlikely that all foreign international students will bring an equivalent common understanding with them.

International students should not be “lumped in” with strategies designed for other temporary foreign workers.  Most temporary foreign workers are required by their visas to work for specific employers; international students may be employed in multiple sectors by multiple employers and may change employers frequently. This adds a further challenge for those seeking to increase protections for and gain the trust of international students and those who employ them. 

Are workers’ comp and OH&S adapting

Workers’ compensation agencies and prevention organizations are not always quick to react to changes in the demographics of their target populations.  International students are a special demographic segment of their target population. 

As noted, Canada, the US and Australia differ from other countries in who has jurisdiction over workplace health, safety and workers’ compensation laws.  Most countries in the world that have social security arrangements for work injuries have national programs.  While efforts to increase the knowledge of residents on workers’ compensation and occupational health and safety  through advertising and inclusion in high school curricula in Canada, the US and Australia; similar awareness programs and educational curricula may not exist in the home countries of many international students.  Failure to adequately inform international students may lead to their injury, potential under-reporting of hazards, and suppression of workplace rights. 

So, what are authorities responsible for workplace health, safety and compensation doing to address this change?  How are they working to communicate worker rights to this unique population, helping their employers understand risks, and making others in the workplaces more aware to foreign student issues?

To be clear, this is not just a question of language.  Nearly all international students are required to have official language proficiency just to qualify for admission as students.  Understanding, trust, access, and support go beyond translating brochures and webpages.  If you can find a workers’ compensation authority or OH&S doing a great job gaining the trust of foreign students, let me know.  I could find no public-facing statements or studies on this issue.  Foreign students need to know that their status and right to work are not at risk by engaging with health and safety agencies or filing a workers’ compensation claim.

I also found little in the way of data on the risk differences (if any) faced by international students.  Do they experience similar levels of injury or risk as resident workers remains an unanswered question.  Few workers’ compensation jurisdictions identify international students in their data –a necessary categorization if we are to determine work-injury risk, claims rates, or establish the likelihood of under-reporting of workplace injury in this population.

Taking action to help protect international students and serve them requires action by workers’ compensation and prevention authorities.  These actions include:

•       Collecting data on international student injuries

•       Interacting with specific international student groups

•       Determining where international students are working and being injured

•       Educating international students and their employers on their rights and building trust

•       Actively seeking to minimize under-reporting of workplace injury, illness and disease involving international students

•       Comparative research on risk, frequency, severity, and outcomes of injured international students vs. resident student workers

Societally, we want and need international students more than every.  They can be a resource that will help level the gaps in our labour force and skill needs. Takin intentional and robust steps to understand and address their needs is more important now than at any point in the past.