Measuring RTW outcomes in Workers’ Compensation: Part 2 – Jurisdictional Approaches

In Part 1, I highlighted three different approaches to measuring return-to-work outcomes:

1.     Standardized calculation based on standardized claims payment data at specific milestone submitted by jurisdictions (AWCBC approach),

2.     Retrospective survey of workers by central researcher group using a stratified sample from each jurisdiction withing strict time frames (Safework Australia),

3.     Retrospective interview approach normalized for each participating jurisdiction (WCRI)

 

Each approach provides insights for stakeholders and policy makers. Comparability and consistency among participating jurisdictions are often primary objectives. 

 

Individual jurisdictions have different objectives in measuring their RTW outcomes, each tuned to the features, priorities, and demands of their jurisdiction. 

 

With that in mind, here are four examples of jurisdictional RTW outcome measures.

 

Texas: 2023 Return to Work

 

The Texas Department of Insurance (TDI), Division of Workers’ Compensation, Workers’ Compensation Research and Evaluation Group (WCResearch) analyzed RTW outcomes for claims between 2007 and 2020 in this report. The report focuses on initial and sustained RTW (defined as a return to work and staying at work for three calendar quarters (9 months) following injury).

 

I asked WCResearch at TDI to expand on the study methodology:

 

The return-to-work report uses data on tens of thousands of employees who received Temporary Income Benefits (TIBs) after a work-related injury, examining wage records from the Texas Workforce Commission to determine when these individuals began earning wages again. The report assesses whether this return was classified as initial, referring to the first time an employee returns to work after the injury, or sustained, defined as maintaining employment for three consecutive quarters. These findings are linked to demographic details such as age, industry, employer size, and benefit type allowing for further statistical analysis. The methodology also includes an analysis of average wages before and after the injury, along with the average number of days employees spent away from work.

 

The results over the study period include the following:

 

92% of employees were back at work within one year.

 

69% of workers back at work within six months stayed at work and achieved pre-injury earnings within two years.

 

Days away from work averaged 43 (median 29).

 

For 2020 injuries, the initial RTW rate at six months post injury was 83%, a bit higher than the average 80% for the 2007-2020 study period. The sustained RTW rate was 69%, higher than the average 63% for the study period.

 

The “sustained” RTW outcome in this report is striking.  The three quarters (9 months) of earnings post RTW is a significant threshold and the objective sources for this data provide a rigour not found in many studies that rely on interview responses.

One challenge with this study approach is the lag necessary for a year’s cohort of claims to fully develop (close) to their ultimate duration. While that is happening, changes to law, policy, practice, and economic conditions may impact current RTW results.

 

Victoria Australia: WorkSafe Victoria RTW

 

WorkSafe Victoria has made return to work a “headline” Key Performance Indicator (KPI) in their Corporate Plan 2023-2024 and Strategy 2021-2024. (https://www.worksafe.vic.gov.au/resources/corporate-plan).  “At a headline level, we measure safe and sustainable return to work outcomes for injured workers with physical and mental injuries at 16 weeks, 26 weeks, 52 weeks and 104 weeks post claim lodgment. A return to work is defined as one that has been sustained for a three-week period.”

 

In Victoria, the claims management function is delivered by third party “agents” with WorkSafe Victoria oversight. Remuneration of agents includes a performance adjustment for meeting targets set for RTW outcomes at 26 weeks. Claims management software requires case managers code RTW status upon case closure and provide for case notes or other documentation confirming RTW details.

 

The following is my summary of WorkSafeVicotria’s methodology for the26 week (182 day):

1.     Calculation:
      Number of injured workers working at 182 days [divided by]                                                                                                     
     Population (paid claims in reporting period with > 10 days weekly compensation paid (including employer excess))

2.     RTW Status Assessment made 182 days post injury.

a.     Assessment of whether the worker has continued to remain at work for three weeks (21 days) following the return to work.

b.     Based on recorded fielded responses in systems (ACCtion, Fineos) and documentation of RTW (email, letter, Novus note, …).

3.     RTW Status Assessment and Validation at 21 days are subjected to random sample audit.

 

Note the exclusion of the 10 days of weekly compensation) in this calculation. Shorter duration absence in this range typically resolves with 100% RTW. Eliminating these from the calculation denominator and the numerator will tend to lower the overall RTW rate than if these cases were included.

 

WorkSafe Victoria’s data relies on the integrity of the information encoded in claims management systems about initial and continued employment at three weeks.  Audits of data entries to confirm the integrity of the coded information is a critical component of this measure.

 

A key feature WorkSafe Victoria’s RTW outcome reporting is the separate tracking of physical and mental injuries.  Mental injury cases tend to have longer recoveries. If a jurisdiction has a larger proportion of mental injury claims, a combined RTW measure will result in a lower percentage of RTW at 26 weeks.

 

For physical injuries, the result at 26 weeks is 73.60%, but for mental injuries, the return-to-work rate was 41.60%. This highlights a significant difference between mental injury cases and other injury types.

 

WorkSafeBC: Key Performance Indicator

 

WorkSafeBC is the operating name for the Workers’ Compensation Board of British Columbia. Its operational priorities include “Maximize overall recovery and post-injury earnings for injured workers”. A key performance indicator (KPI) to track progress against this priority objective is included in their Annual Report and Service Plan.

 

The KPI, “Improve return-to-work outcomes” carries the description: “The percentage of B.C. workers who return to work within six months (26 weeks) of their work-related injury.” The calculation method as stated in the 2024 Annual Report and 2025-2027 Service Plan (p. 34) is described as follows: 

 

“This KPI measures duration (by 26 weeks), whether the return to work is voluntary (the worker does not object), and whether it is safe and durable, with no subsequent inability to work for 30 days. To track the percentage, we compare the number of claims meeting these criteria with the total number of wage-loss claims open for more than 26 weeks.” [emphasis added].

 

Fielded case management data are used to determine status on closure. The absence of a claim re-opening indicating an inability to work infers durability.  There is no explicit confirmation of sustained RTW or return to full earnings.  

 

The KPI results reached a high of 81.3% in 2022 before falling to 78.5% in 2023 and rising again to 79.7% in 2024. The target going forward is to achieve 81.0% return to work by 26 weeks. (Note:  AWCBC records 85.00% (2022) and 83.62% (2023) under 25.5-Percentage of Wage-Loss Claims off Wage-Loss Benefits at 180 days (%)

 

There is no waiting period in British Columbia’s workers’ compensation system, so the results capture many very short duration claims.  These cases tend to have very high successful RTW outcomes.  Self-insurance is allowed in BC but not self-administration, so the results include for these deposit-class employers (governments, certain large employers) are also reflected in this measure.

 

South Australia: return-to-work milestones

 

When you rebrand your workers’ compensation authority “ReturnToWorkSA”, the messaging is clear. As you might expect, RTWSA has measures that reflect RTW status at various milestones such as 4, 12, 26, 52, and 78 weeks.

 

The data-rich report on ReturnToWorkSA Insurer Statistics FY2024 provides RTW outcomes for the 26-week milestone, similar to others noted in this part.  This time, there are three RTW status outcomes noted: “Not at work”, “Partially at work”, and “Fully at work”.  This reporting reflects a level of importance on “stay at work” outcomes within the system.  

 

The four-year time series provided for this milestone reflects a trend toward fewer workers not working and an increase in the number and proportion of workers fully RTW:

 

Not at work 5.7%,

Partially at work 3.5%,

Fully at work 90.9%. 

 

This is a population-based study reporting on 12,121 cases in the 2024 result.  According to RTWSA:

 “The milestone is measured from the workers first date of work incapacity, or injury date if the worker does not have work incapacity. Improvement has been achieved with a multifaceted program of work aimed at improving services to injured workers and employers.”

 

Note the subtlety of a worker suffering a work injury but not a work incapacity. The accepted claim covers the medical costs, but the worker may continue working on modified duties as part of a stay-at-work program, an approach actively promoted by RTWSA.

 

Summary Comment

 

Jurisdictional approaches to measuring RTW outcomes are often specifically crafted to address particular needs and priorities.  Where the national measures must find commonality among the jurisdictions, individual jurisdictions can allow the unique data systems and to provide greater depth.  Each approach starts with a purpose, and each design has its limitations.  In general, the results highlighted by the measure lag significantly behind changes in policy or initiatives to improve outcomes. 

 

Texas can focus on sustainable RTW outcomes, WorkSafe Victoria can differentiate results for mental and physical injury cases, and ReturnToWork South Australia can provide data on partial RTW and include successful stay at work outcomes that might be excluded from other designs.

 

Note the different approaches in determining sustainability.  In Part 1, we saw Safework Australia and WCRI ask workers directly about their work status as the time of interview. Their retrospective methodology builds in significant distance from initial RTW to assess sustainability of the RTW.  In Part 2, we see WorkSafeBC uses a case criterion “with no subsequent inability to work for 30 days” to exclude non-durable RTW outcomes from its measure, while WorkSafeVictoria uses an audited 21 day record (or direct/indirect inquiry) to assess whether the worker has continued to remain at work.

 

Again, there is no one “right way” to measure RTW outcomes.  Those jurisdictions willing to participate in studies, establish well defined measures, and post transparent results allow leadership, stakeholders, and policy makers assess performance and achieve better outcomes for injured workers and their families. 

In Part 3, we will look at RTW outcome trajectories. 

 

[This post was prepared as a resource for DMCCT- Evaluating DM Programs & Assessing RTW Processes, Pacific Coast University for Workplace Health Sciences]

 

How do I get started using AI in Disability Management?

 

“Ai won’t replace people… People who use AI will replace people who don’t.”  [* IBM, “Augmented work for an automated, AI-driven world”, https://www.ibm.com/thought-leadership/institute-business-value/en-us/report/augmented-workforce  accessed Oct 5, 2023]

IBM’s assessment applies to Disability Management professionals, Rehabilitation Consultants and Personal Injury Advisors as well as clinicians, administrators, and even CEOs; those who use artificial intelligence (AI) will replace those who don’t. 

When that realization sinks in, students and participants in my workers’ compensation courses and disability management seminars often ask, “How do I start using AI?” 

Here’s what I tell them.

Step 1:  Get access to an AI chat application.

While ChatGPT is the highest profile, other popular AI chat applications like Bard, Bing’s Chat and Perplexity are available for free access in most countries (or through VPN access) subject to registration.  Subscription-based and more specialized AI applications are also available.  If your organization already subscribes to one, you may want to get started with that.

Step 2:  Create a prompt.

Chatbots respond to you.  Unlike an internet search engine, AI chat applications apply Large Language Models to what you “prompt” (the question you write or speak as an input to initiate a chat session.  One person described their first experiences with AI chats this way: “It’s like texting a detailed question to a really knowledgeable expert and getting a really complete response… but with no time lag.”

Step 3:  Interact with the application.

In an internet query, you typically ask one question then investigate by following supplied links from the response.  With AI, you can carry on a conversation; most chat applications allow you multiple (five to thirty or so) follow-up prompts, questions, or comments to which the AI chat will respond  Subsequent prompts may ask for more detail or a justification of a particular response.  You can probe, disagree, or ask for a response to be put another way.  The AI chat applications are pretty good at following the chain of conversation without restatement information already appearing in the session.

Step 4:  Review responses critically and with caution

If you are already knowledgeable about something, start with a prompt that will allow you to evaluate the responses.  AI chat applications are not authorities; they just present information in a way that sounds definitive.  In their present state of development, they make errors, hallucinate, and miss key points while emphasizing sometimes trivial matters.  What you bring to the interaction is your knowledge and judgement.  The experience of detecting and exploring errors, omissions, and overstatements will help you evaluate responses when you are not expert.

Step 5:  Verify

Most chat applications will now provide sources to support their responses either directly or if prompted.  This is important for any work you do at least at this stage in AI development. Check the references provided very carefully.  Read the papers cited to see if they actually support the statements made in the AI response. 

Practice with AI applications will help you develop your prompts to be more effective.  Here are some examples of how AI can inform and assist disability management professionals, stakeholder and advocates in their practice.

Use AI to understand appeal case decisions.

The Appeal Commission for Alberta Workers’ Compensation publishes “Significant Decisions”  on commonly appealed issues in workers’ compensation [see https://www.appealscommission.ab.ca/resources/significant-decisions] .  The selected cases are particularly clear in their organization, analysis and application of principles.  The decisions are listed by topic but not summarized or annotated.  For example, the Appeal Commission’s website lists two decisions by number under the heading “Claim Acceptance” [see Decision No. 2014-1090 , Decision No. 2014-0657].

In this example, I took the text of the two listed decisions and uploaded them to ChatGPT with the following result: 

Prompt: 

Based on the two exhibits, prepare a short summary of about 250 words for each case then provide several paragraphs outlining the principles, analysis and approach that advocates can use to inform their submissions on the acceptance of workers' compensation claims.

ChatGPT response:

Case Summary 1: Left Shoulder Labral Tear

 

In this case, a worker filed a compensation claim for a left shoulder labral tear. After examination, the first medical consultant indicated that the worker's job duties, which included frequent work in an "impingement position," likely contributed to the injury. The third orthopaedic surgeon, however, deemed the examination invalid and could not correlate the symptoms with the described injury mechanisms. The Appeals Commission ultimately sided with the first medical consultant, citing his detailed review of the worker's job demands and physical analyses, which the third orthopaedic surgeon failed to do. They also noted that the third surgeon's opinion lacked a clear rationale.

 

The Commission emphasized the absence of evidence supporting an alternate cause for the diagnosed labral tear, ruling out other potential factors. Consequently, the worker's left shoulder labral tear was deemed compensable due to the consistent medical evidence and job-related factors.

 

Case Summary 2: Left Medial Epicondylitis

 

The worker in this case was diagnosed with left medial epicondylitis. Although medical evidence confirmed the condition, it did not sufficiently establish a causal relationship with the employment hazard. The medical consultant suggested that the worker's significant exposure to force, repetition, and abnormal postures in forearm-related activities could reasonably relate to his job activities. However, the Commission found this insufficient to establish causation, as the consultant also noted that the worker reported elbow symptoms after ceasing work.

 

Additionally, the third orthopedic surgeon's examination did not support a causal connection between the worker's duties and the medial epicondylitis. The Commission emphasized that absence of evidence for an alternate cause did not automatically establish a causal link. Therefore, the claim for left medial epicondylitis was not accepted.

Principles, Analysis, and Approach for Advocates

Detailed Job Analysis: Advocates should emphasize the importance of conducting a comprehensive review of job demands and physical analyses when assessing the causal relationship between a worker's duties and their injury.

 

Clear Rationale for Opinions: Medical consultants and experts should provide a clear and detailed rationale for their opinions, ensuring that they explain the basis for their conclusions.

 

Consideration of Timing: Advocates should be aware of the temporal relationship between the reported injury and the cessation of work. This can be a critical factor in establishing causation.

 

Evaluation of Alternate Causes: While absence of evidence for an alternate cause is relevant, it alone is not sufficient to establish a causal link. Advocates should focus on gathering evidence that directly links the injury to the employment hazard.

 

Specialized Expertise: Advocates should consider the qualifications and expertise of medical consultants, especially in comparison to other examining professionals, to determine the weight given to their opinions.

 

These principles, rooted in the Appeals Commission's decisions, can guide advocates in constructing strong submissions for workers' compensation claims, ensuring they are well-supported and likely to be accepted.

 

Note that the result is highly dependent on the prompt and the AI model used.  Even replicating the above example in the same AI application will likely result in a similar but not identical response.  Changing or omitting the word count will also change the detail in the response.  If you have a decision letter on a similar claim, you can test if the principles identified in the first response are properly applied in a subsequent case.

 

Develop a job modifications and adaptations to accommodate a return-to-work  objective

In the following example, the prompt includes the instruction to assume a particular role in developing a GRTW plan.  This is a hypothetical example and for confidentiality and privacy reasons, actual names and circumstances should be avoided as you experiment with AI.

In this example, note that the prompt prescribes a point of view, an assumption of a professional position.  Note also the details contained in the prompt.

Prompt:

Assume you are a vocational rehabilitation consultant assisting a 40-year-old bank employee return to work. The employee was pursuing a hobby involving woodworking. Having removed the guard on the table saw to make a close cut, the employee amputated the ring and middle fingers on both hands below the medial pharyngeal joint. The employee is recovering well enough (after three months away) to return to work. The job duties involve a lot of sedentary work with extensive keyboarding using a standard desktop computer, keyboard, and mouse. Phone calls are made and received through a standard desktop phone with a headset. The employee has full use of thumbs, third and little finger on both hands. What modifications, devices, and adaptations to the workstation would you recommend to accommodate this employee's

ChatGPT Response:

Given the employee's condition, I would recommend the following modifications and accommodations:

 

Ergonomic Workspace: Ensure that the workstation is ergonomically designed to reduce strain on the remaining fingers and thumbs. This includes proper chair height, monitor placement, and keyboard/mouse positioning.

 

Specialized Keyboard and Mouse: Consider providing a keyboard and mouse designed for individuals with limited dexterity. There are options available with larger keys or alternative input methods like touchpads.

 

Voice Recognition Software: Implement voice recognition software to reduce reliance on extensive keyboarding. This would allow the employee to dictate text and commands.

 

Keyboard Shortcuts and Macros: Set up customized keyboard shortcuts and macros to streamline tasks and minimize the need for complex typing.

 

Adjustable Desk: Provide a desk with adjustable height to accommodate any specific needs related to the employee's comfort and posture.

 

Phone with Speaker Functionality: Use a desktop phone with speaker functionality to allow the employee to use it without needing to hold the receiver.

 

Headset with One-Sided Earpiece: Opt for a headset with a one-sided earpiece to allow the employee to use the phone while still having a free hand for typing.

 

Document Holder: Provide a document holder to keep necessary documents at eye level and reduce strain when referencing them while typing.

 

Wrist Rests and Palm Supports: Include wrist rests and palm supports to provide additional comfort and stability during keyboarding tasks.

 

Monitor Mounts: Use adjustable monitor mounts to position screens at an optimal viewing angle for the employee.

 

Training and Support: Offer training on any new assistive technologies or workstation adaptations to ensure the employee is comfortable and proficient in their use.

 

Regular Check-Ins: Schedule regular follow-ups to assess the effectiveness of the accommodations and make any necessary adjustments.

 

Remember to consult with the employee throughout this process to understand their specific needs and preferences. Additionally, consider involving an occupational therapist to provide specialized guidance if needed.

 

This is a detailed outline but a bit short on details.  Follow-up questions can ask for additional information.  You could, for example, expand on the alternative keyboards items.  In my follow up, the idea of a hand-held keyboard about the size of a smartphone allowing for typing with the thumbs similar to texting was suggested. 

 

Draft a return-to-work plan

For this example, I gave the employee in the hypothetical case a name and relationships and asked the AI chat to prepare a return-to-work plan with the following prompt. 

Prompt:

Assume the employee, Arlene W., is cleared to gradually return to work in two weeks.  The employer has agreed to the points above.  Develop a formal return-to-work plan outlining what happens each week for up to 8 weeks with the employee back at full duties at the end of the plan.  The plan will be overseen by the employee’s supervisor, Jay Q., and the RTW coordinator, Peter L.  Any adjustments to the plan will be agreed upon by all three parties.  The plan should be formatted as an agreement using the calendar weeks and dates that would apply.

I’ve posted the ChatGPT response as an image and a PDF (some formatting added). 

The product is well organized but sparse in detail.  That is understandable given the brevity of the prompt.  Adding more details could result in a more detailed. In practice, the output could be used as a starting point.

As an additional exercise, paste an anonymized version of on of our own RTW plans into an AI chat with a prompt as follows:  Review the following return to work plan commenting on its completeness, pointing out any deficiencies and make recommendations for amendments, deletions, or other changes. 

This exercise is framed as a self-check, something you might do in your own practice, but that is too narrow a perspective.  You can be certain that many of those receiving your RTW plan proposal will run a similar exercise as part of their own due diligence before signing off on your proposal.

Recommendations

I’ve stressed the need to be knowledgeable about AI but to be cautious in its implementation.  The only way you can develop your understanding of AI is by using it! 

And, keep in mind these  four recommendations, one hint, and a final caution:

•  Start interacting with AI tools now to become familiar with their evolving utility.
• Be sure to adhere to all ethical, confidential, privacy and academic integrity guidelines.
•  Practice being critical of AI responses. (Hint:  Practice by creating AI prompts that will generate responses in your area of expertise and examine the response for errors, omissions, and misinterpretations or outdated perspectives).
• Verify information before using AI information (AI is NOT an authority even if its responses are framed as authoritative assertions).

 

Remember, AI chat applications are known to hallucinate, make up quotes, and attribute them to articles that may not exist.  If you catch AI making an error or flawed reasoning, follow up with the AI application.  It is very common for AI chatbots to apologize, acknowledge their errors, and amend their responses—but only if you pursue the point. 

AI is here to stay, being integrated into existing technologies,  and continuing to evolve.  Use it to make a difference in your profession.

Do employers need a workplace Contact Tracing plan or app?

If you are an employer, you have a positive duty to protect workers from harm.  Industry-specific guidelines on how to do that in the COVID-19 environment are now published by occupational safety and health organizations (such as  CDC, SafeWorkAustralia, and WorkSafeBC). The physical barriers, personal protective equipment, physical distancing, cleaning guidance and safe-work protocols required to discharge this duty are essential preventative measures. 

Prevention is rarely perfect.  The safeguards, barriers and defenses put in place to protect workers from harm may be subject to inadvertent active or latent defects;  despite multiple layers of precautions, when gaps or defects in prevention align, workers in your workplace may well be exposed to harms including the COVID-19 virus. 

Every jurisdiction has specifically emphasized employer responsibilities during this pandemic.  For example, consider this guidance to employers in Ontario:

The employer is required to take every reasonable precaution in the circumstance to protect the health and safety of workers, and do a risk assessment to determine what parts of the jobsite and what other workers the affected worker would have had contact with.

Based on this risk assessment, the employer may be required to:

• send co-workers who were exposed to the worker home for two weeks. Ask them to self isolate and self monitor and report any COVID-like illness to their employer
• shut down the job site while the affected workplace area and equipment are disinfected

[See Government of Ontario, COVID-19 (coronavirus) and workplace health and safety]

No employer wants any worker to be exposed to or infected by this virus; nor does anyone want to see operations shut down or healthy employees quarantined.  Yet, close contact exposures may occur in your workplace; planning for them can mitigate the impact on your employees and operations. 

Just the facts

The science around COVID-19 is still developing but there are four very important facts to keep in mind:

1. COVID-19 is a respiratory illness contracted when virus particles are either directly inhaled from droplets expelled by an infectious person or indirectly transferred from contaminated surfaces to face, eyes, mouth or nose. 
2. After unprotected close contact with an infectious person or contaminated surface, an exposed person’s symptoms may develop during an incubation period of 14 days, however, up to a quarter of those infected are asymptomatic. 
3. An infected person is infectious to others during a communicability period; that period for those with mild symptoms begins two days before the onset of symptoms.  Infected persons are considered infectious until 10 days after onset of illness, as long as they are fever free and have improved. Those with more severe cases may be infectious until two consecutive negative laboratory test results, at least 24 hours apart, which could take weeks to establish.
4. Just because a person is no longer infectious does not mean they are fully recovered.  Lingering symptoms including fatigue, cough, respiratory and neurological issues may persist. 

Exposure and Close Contact

Unless you are in the healthcare sector, you or your employees may not know when, where, or exactly how an exposure to COVID-19 has occurred.  It is very unlikely a customer will produce a sudden, uncovered cough or sneeze then announce, “I’m positive of COVID-19”.  (If that every happens, your response as an employer would have to be immediate).   More likely, an employee or public health contact tracer will report a close contact exposure, an illness suspected to be caused by the coronavirus, or a positive test result.  The actions you take next are critical to stopping the spread of the disease in your enterprise and the broader community.   

COVID-19 is a respiratory illness.  Your employee breathing in a quantity of droplets from an infectious person, for example, is certainly an exposure that may lead to the development of the disease.  The now ubiquitous plexiglass shields erected in workplaces prevent some of that, but surfaces, tools, and containers may become inadvertently sources allowing a worker to transfer virus particles to their hands then to their eyes, nose or mouth.  Just because a barrier is in place does not mean all potential contact in the workplace has been eliminated; nor do the precautions you take eliminate the possible introduction of the virus into the workplace by other routes. 

Workers may also be exposed to the virus outside the workplace and not realize they have been exposed. Crowded spaces like transit, house parties, and shopping venues have been identified as places where the virus easily spreads.  An employee may be exposed in any of these settings, become infectious, and expose others at work. 

You employees may be exposed at work or in the course of their employment.  It is not uncommon for a worker, customer, or other person in the workplace (such as a delivery person, courier, student, service technician, inspector) to begin to feel symptoms while at work.  Infectious persons (possibly asymptomatic or pre-symptomatic) in “close contact” with workers or customers may inadvertently and unknowingly expose others in the workplace. Definitions of “close contact” vary but if you work within two meters (6 feet) of another worker, customer, or other person in the workplace for fifteen minutes or more, you would likely meet the definition in most jurisdictions. 

Not all exposures or close contacts with a person who is infectious will result in illness. With the knowledge that some people are asymptomatic or pre-symptomatic but infectious, we now know that exposures to this virus may be more common and less obvious than in the above example.   In many cases, the first sign that one of your workers was exposed will be when they report being ill.  Where they were infected may not be obvious.  Their safety and health are paramount but beyond that, investigating the source of the exposure and protecting workers and others in the workplace must be your priority.

A Workplace Scenario

As an employer, you are likely to encounter a case of COVID-19 in your workplace at some point.  Whether or not an employee becomes infected in the course or employment, you are going to have to determine who came in close contact with a source of the infection (an infectious customer or co-worker, contaminated surfaces or discarded tissues used by an infectious person) , which employees should be quarantined, and when the diagnosed and quarantined employees can return to work.  Acting quickly is critical to stopping the spread of the virus and limiting the impact on operations.

Consider this scenario:

Anna and her two other team members worked in close proximity Monday to Thursday.  They did their best to keep physically distanced, but the nature of their work meant working side by side for periods of time.  On Friday morning, Anna woke with a dry cough, headache and fever.  She called her manager’s line and left a message regarding her symptoms; she then called her doctor who told her to self-isolate and immediately referred her to testing.  On the following Monday morning her test results were received:  positive for COVID-19.  After receiving the diagnosis and instructions from her physician, she called her manager with the news.

As Anna’s employer, you will be concerned for her.  You will also have concerns for your other staff and your production.  While it may not be clear if Anna contracted the disease at work, you have a duty of care for your other employees who were in close contact with her and others who may have been exposed through the immediate operational space.

When can my employee return to work?

In the above scenario, Anna will be told to isolate and will not be returning to work for at least 10 days from symptom onset. Isolation prevents sick persons from spreading the disease to others, including family members.  Isolation means not going out for food or entertainment and definitely not to the workplace.

If Anna is well enough and can work from home while isolated, that may be an option; she can’t end her isolation until she is no longer infectious.  The infectious period begins two days before the onset of symptoms and extends for at least 10 days even if symptoms subside.  Beyond the 10 days, isolation is required until the worker is fever free for three days and all other symptoms are resolving. 

Even though the isolation period may have ended, workers like Anna may need more time to recover from other symptoms to return to work. For some occupations, another test may be necessary to confirm a worker is no longer infectious.  Although no longer infectious, many who recover from COVID-19 experience fatigue and other symptoms that may delay a full, safe, and durable return to work.  Your “duty to accommodate” a worker extends to such cases. 

What about close contacts?

Remember, Anna was likely infectious for the two days prior to symptom onset.  It is likely her team members were in close contact with her during that time.  Cleaners, supervisors and others who visited Anna’s work area may have been exposed.  Perhaps she met with her manager or another team concerning the next project.  None of those employees may report being ill (or ill yet). 

The sooner well employees are informed of their exposure, the better the chances of arresting the spread of the disease.  As a precaution, workers with close contact should be told to self-quarantine for fourteen days from the date of exposure.  Quarantine is a means of restricting the contact and movement of a person who has been exposed; it prevents the spread of disease to others.  The following concisely describes what Anna’s close contacts will be expected to do 14 days from last contact with her:

• stay at home and monitor yourself for symptoms, even just one mild symptom
• avoid contact with other people to help prevent transmission of the virus prior to developing symptoms or at the earliest stage of illness
• do your part to prevent the spread of disease by practicing physical distancing in your home

[see How to quarantine (self-isolate) at home when you may have been exposed to COVID-19 and have no symptoms, https://www.canada.ca/en/public-health/services/publications/diseases-conditions/coronavirus-disease-covid-19-how-to-self-isolate-home-exposed-no-symptoms.html]

Exactly how your enterprise will handle COVID-19 absence for those who must isolate or quarantine is up to you.  It may require amended sick-leave policies, new procedures for initiating quarantine, and even supports to enable quarantine to be effective.  Your quick action can prevent cascading exposures to other workers, their family members, and the broader community.  If Anna’s test results are negative for the COVID-19 virus, then her continued self-isolation and quarantine of her close contacts would not be necessary.

If informing employees waits until there is a positive test result, the implications may be more profound. The well employees may have returned to work on Monday morning but once Anna (or a public health contact tracer) makes you aware of the positive COVID-19 test, all employees having had close contact with Anna must quarantine for fourteen days following the last close contact.  The potential length of the quarantine does not change but the delay in starting their self-isolation raises the potential for Anna’s close contacts to unknowingly become infectious and infect others at work, home or in their community.    

In the scenario above, Anna experienced the first symptoms on Friday morning and got her test results on Monday.  That may be close to the ideal case.  Had she come to work ill, the potential for a wider exposure would expand.  The fact she stayed home and got her test result so quickly means she had limited contacts and the virus had limited opportunities to spread.  Co-workers with close contact would count their quarantined period from their last close contact.  Team member that worked with Anna on Wednesday or Thursday would count their quarantine date from their last close contact with Anna.  Hopefully, quarantined employees will not get sick but if they do, they will not spread the disease further.  Quarantined workers can return to work once the quarantine period expires if they are otherwise healthy and symptom free.

Can I leave identifying close contacts up to public health contact tracers?

Public health contact tracers have special training and knowledge to do their jobs but you, as an employer, have a duty to protect your workers.  As an employer, you have important information for contact tracers. You know your workplace and are in the best position rapidly identify close contacts.  Your attendance records, work schedules, employee contact information, building entry logs, and meeting minutes can help you rapidly identify close contacts and prevent wider exposure.

It may be that you as an employer will be contacted by public health with information that an infectious customer, technician or other person was at your workplace, raising the possibility of close contact exposure.   Your records of who was working with or serving that customer will be important to the contact tracer but also to your ability to fulfill your duty of care for your employees.  Remember, the faster exposures are identified, the sooner the spread of the virus can be halted; the impacts on your workers’ health and your operation’s production are limited the sooner you act.

Isn’t there an app for that?

Many countries and some employers are mandating or recommending smartphone apps or other technologies to facilitate contact tracing.  Korea, Singapore, the UK, Iceland, Norway and others have implemented programs with varying degrees of success.  The apps generally use Bluetooth technology to register either location and/or proximity to others with the app or tracking “token”.  If a person is identified as infected with COVID-19, the app can quickly identify others who may have had close contact during the infectious period. [see Ryan Brown, Why coronavirus contact-tracing apps aren’t yet the ‘game changer’ authorities hoped they’d be, CNBC, July 3, 2020].

These apps are not without controversy.  They only work well if widely enabled on many devices, so public acceptance (or government mandate) are required.  In Singapore, for example, temporary foreign workers are required to carry a tracking token and that interacts with the nationally mandated smartphone app (voluntary for citizens).  [see Saira Asher, Coronavirus: Why Singapore turned to wearable contact-tracing tech, BBC News, Singapore, 5 July 2020].  Not all smartphones are capable of handling contact tracing apps and those with greatest vulnerability such as lower income citizens and older individuals may not have access to the latest technology.          

Corporate apps are also available.  These may be adopted and mandate by a firm for employees but there are both privacy and efficacy issues.  Not everyone is OK with 24 hour a day GPS tracking by an employee or a government.  Questions about how data will be collected and used are often raised. 

Privacy issues aside, efficacy issues include the false positives of proximity.  Even if the app only measures proximity to another smartphone for a given period (say, 15 minutes), that may not mean any exposure has taken place.  Just because the agent renewing your insurance or the Uber driver were taking you to your appointment were close enough to register contact in a tracing app, the presence of a plexiglass shield  or divider will not be registered;  if either you or the other person is identified as infectious, the close contact warning would be a false positive.  The converse is also true; a missed close contact is like a false negative.  If an infectious person does not have the app or token (or the device is out of power or app not enabled), no close contact can be recorded.  Tracing apps cannot record proximity to environmental exposures and may yield a false sense of security.   These technologies cannot detect the virus; they only detect proximity (or location, in some cases).  

Take action now

Before COVID-19 hits your workplace, put your plans in place.  Besides doing what is necessary to comply with OSHA and public health orders or guidance, you need to have a plan for what to do when an employee or public health identifies a COVID-19 exposure or transmission. Your plan may include containment and decontamination teams, but you will need to address policy issues like when and how to isolate, deep clean and disinfect the area concerned.  Your personnel plan for containment, informing close contacts, supporting quarantine, isolation and return-to-work is even more important.  The speed and thoroughness of your actions to stop the chain of transmission is essential to the safety and health of your employees and others in your workplace.  With that in mind: 

1. Prepare:  develop policies and procedures so staff know what to do if they feel ill and particularly if they are diagnosed with COVID-19.  Privacy laws and policies will vary so keep those in mind as you prepare.  Confidentiality is important and safeguards should be built into your policies and procedures. Involve staff and union representatives in your plan development. Consultation, addressing concerns, developing policies, and then training staff will challenging in the COVID-19 era but critical to your planning and preparation.   
2. Update and keep current:  Where people work, seating floor plans, travel records and entry/exit logs need to be accurate and immediately available when required.  Meetings may not always have minutes, but every meeting should have a record of attendees, location and times. Update employee contact information for home, mobile phone numbers, and email.
3. Operationalize your plan:  Assign specific resources to manage suspected or known COVID-19 exposures.  Delays in identifying close contacts can result in wider spread within your operations and beyond.  Having key resources familiar with operations and records, knowledgeable of your policies and equipped with the commensurate authority to act will be necessary.  Be sure to build redundancy into your plan. Your plan needs to operate even if the specific resources become ill or unavailable.
4. Consult, train, build awareness:  Your operations depend on people.   The very steps necessary to limit the spread of COVID-19 and facilitate contact tracing need to be understood and concerns addressed in advance of any need.  Activity logs, attendance at meetings, entry and exit logs are necessary but concerns over why they are needed, how long they will be kept, who has access and the purposes allowed for that access need to be clear and understood.  Build awareness of your plans and why the procedures are needed to protect workers and others in the workplace.
5. Build resilience:  For the near to medium term, COVID-19 is part of our reality.  Anticipating the consequences of exposures and close contacts in your workplace can mitigate against the greatest impacts and accelerate your ability to keep workers safe and restore operations.  Having your plans and resources in place, assigning and cross-training personnel, and testing your plans are essential to restoring and maintaining the health and safety of your employees and the success of your operations.

COVID-19 will be in our workplaces for some time—likely measured in years rather than months.  Whether this or some other infectious disease, workplaces must adapt in ways to protect workers and others in the workplace.