Are there systemic barriers to reporting injuries and filing claims?

A worker gets injured in a work-related incident yet there is no record of a work-related injury with the state or federal agency responsible for recording this information.  Unfortunately, this scenario gets played out every day in workplaces everywhere and leads to complaints about “under-reporting.”  Tracing the causes behind the under-reporting can be complex;  some are very personal while others are systemic and should be addressed.

Why is full reporting of work-related injuries important in the first place?  An accurate, timely injury report is an indicator of failures in the safeguards, defenses and barriers in the workplace that prevent hazards from injuring workers.  Training, supervision, adherence to safe work procedures and design are what control the risks associated with any enterprise from shop-floor manufacturing to teaching a college course.  When an injury occurs, it reveals a pathway or trajectory between the hazard and the worker.  The failures may be inherent or active but knowing about them is important is the first step to fixing them.  Failure to report the incident to the responsible agency (OSHA, State OSHA, Provincial Ministry of Labour, WorkSafeBC,  etc.), may place  other workers at risk. 

The failure to attribute a work-related injury to work activity means the healthcare costs for diagnosis, emergency treatment and rehabilitation may be externalized to taxpayer-funded universal healthcare or premium supported medical plans.   That lets the specific industry  that gave rise to the injury off the hook and can drive up premiums and costs of taxpayers and non-occupational medical coverage.  Even if the non-occupational health plan is paid for by the employer, the attribution of work injuries to non-work activity may influence premiums for all participants in private or taxpayer-supported health plans. 

Why would anyone not want to report a work-related injury?   From a worker perspective, particularly if the worker is young, new in the job, or in some form of precarious employment, there may be fear about the consequences of reporting the injury or making a claim.  In some cases, despite real and often quite severe injury, the worker will deny a work connection to a physician or emergency room staff.  I have heard workers say, “getting injured is just part of the job” and unless they are taken away in an ambulance they just shrug it off.  Nurses, doctors, fire fighters, police and corrections officers, and construction workers are among those most susceptible to this line of thinking.  Surveys have found that many workers believe getting injured or developing an occupational disease is just an inevitable consequence of work.   Getting injured is not inevitable or just part of the job, but these sentiments are often perpetuated by workplace culture.

Even well-meaning initiatives can result in suppression of work-related injury reporting.  “Safety incentive programs” that reward groups for injury-free status fall into this category.

Sometimes the systemic barriers are an unintended consequence of procedures designed to make a system fair or more efficient.  Although combining worker and employer reports of injury into one may be seen as a means of streamlining and reducing duplication, it may have the unintended consequence of putting the employer in a heightened power position over a vulnerable worker; the worker may seek to avoid that situation and, as a consequence, the injury goes unreported.  Even features such as filing claims by telephone or over the internet may pose barriers for workers with language or communication challenges. 

Scheme design can also create barriers.  Many knowledgeable commentators are concerned about premium incentives such as experience rating that may contribute to suppression of injury and workers’ compensation reporting.  A rational or unjustified fear of the consequence of injury reports on experience rating may inadvertently encourage managers to “absorb” the cost of work absence and health care due to work-related injury under other leave and care plans.  Every review of an experience rating system should include an examination of its consequences on injury and claim reporting.

Active suppression of injury reporting and worker’ compensation claim filing is prohibited in most jurisdictions.  Beyond the illegality of these actions, they have the consequence of putting others at risk, increasing the cost of work-related injury to the injured worker (family and community), and increasing the costs to other public and private insurance plans—creating an unintentional subsidy to the industry giving rise to the injury.  

Work-related injuries can’t happen here…can they?

One of the biggest barriers to improving health and safety is the belief that work-related injury, disease or death “can’t happen here”.  I’m not saying injuries are an inevitable part of work.  What I am saying is that believing work-related injuries are not possible actually makes it more likely they will occur. 

A teacher commented to me that workplace health and safety really wasn’t an issue where he worked—a high school.  The only health and safety issues he could identify involved the occasional issue in one of the industrial education or foods classes.  “Schools are safe places for students and staff.  Work-related injuries can’t happen here.” 

I agreed that schools are generally safe for students and teachers but hazards and risks of injury are present in every workplace in every sector—including education.   I listed Sandyhook,  Columbine,  Virginia Tech,  and École Polytechnique as high profile examples of a very real risk of  violence in the education sector that has lead to the injury and death of students and workers.   These tragedies tell us about very real risks—risks that have been identified and have led to most schools to perform a risk assessment and develop new procedures.

He conceded that his school now practiced procedures in the case of an intrusion but he put the risk of such an incident right up there with earthquakes and fires:  possible but not probable.   “These are rare events—terrible but rare.  Work-related injuries to teachers, teaching assistants, administrators and other staff in educational settings just don’t happen in day to day work…do they?”

That little bit of doubt provided an opening.  I agreed to check and sent along the following table [data from http://worksafebc.com/publications/reports/statistics_reports/occupational_injuries/default.asp ] :

That’s 10,000 claims for short-term disability or new long-term disability or survivor benefits in British Columbia alone in the last ten years.  Most common injuries were strains and sprains from over exertion or falls on the same level , but hundreds were injuries caused by violence or acts of force including biting, kicking, scratching and hitting. The average age for injured workers in most of these occupations was in the mid 40’s and these injuries were serious enough to cause a work absence.  Getting seriously injured is never “just part of the job” (another widely-held attitude that has to be challenged).   

Injuries can occur in any workplace including schools, colleges and universities.  Work involves risks; complacency and an unfounded belief that “work-related injuries can’t happen here” heighten the probability of injury.  Joint Occupational Safety and Health meetings, safe work procedures, safety plans, new worker safety orientation, ongoing safety training are all part of controlling the apparent and hidden risks in every workplace including all educational settings.

Whether you work in an office, hospital, school or factory, there are ongoing risks to your health and safety.  This is a fact.  It is not meant to scare you.   Unless you believe work-related injuries are possible, that “It really could happen here,” you won’t really engage in the health and safety training, orientation, or practices that make workplaces safer and healthier for everyone. 

How do I know if our Joint Occupational Health and Safety Committee is effective?

The research literature reflects a consensus that effective joint occupational health and safety committees (JOHSCs) make a difference in the workplace.  Just because you have a JOHSC that meets the regulatory requirements, is properly constituted and meets regularly does not guarantee its effectiveness.  How would you assess the effectiveness of your committee? 

A good place to start is with the questions on the Canadian Centre for Occupational Health and Safety (CCOHS) website at http://www.ccohs.ca/oshanswers/hsprograms/hscommittees/effective.html: 

1.       Are members' duties clearly defined?
2.       Is a list of duties available to each member?
3.       Do members understand what their duties are?
4.       Do members carry out their duties?
5.       Is the structure and duties reviewed periodically and revised when necessary?
6.       Do members know the extent of their authority?
7.       Do members exceed their authority [or fail to address health and safety issues within their authority]?
8.       Are the chairperson's duties and authority clearly specified?
9.       Are the secretary's duties clearly specified? 

This is a great starting point in assessing the effectiveness of your JOHSC.  If all members of the JHSC have positive responses to all questions except 7, you have the makings of an effective committee.   I’ve added the clause shown in square brackets to question 7 for a reason.  If there is any doubt in the responses, mixed responses, or if you find question 7 responses depict a committee or its members exceeding their authority or failing to exercise their authority, your committee may not  working as effectively as it could.  In this case, failure to address substantive issues within a committee’s authority may be more serious than overzealousness.  If a committee’s members find they are continually bumping into issues that are beyond their understood authority, there may be something wrong with their understanding or the responsibilities and authority defined for the committee.  In either case, the health and safety of workers and other persons in the workplace may be at stake.  At a minimum, a “yes” answer to question 7 should spark some serious discussion.  

The CCOHS questions (with my proposed amendment to question 7) are internally focused.  A important measure of effectiveness is the degree to which the JOHSC is perceived by management and staff to be an important and potent facet of health and safety in the workplace.   So, I recommend adding the following question to the list:

10.    Do management and staff perceive the JOHSC to be effective?

There are many ways of informing a response to this question.  The methods include:

·         Directly asking managers and staff members the question in a staff survey
·         Counting of issues and questions referred to the committee as a performance measure
·         Tracking the number of page visits to the JOHSC minutes posted to the organization’s intranet site

Each of these or several in combination will provide an indicator of the importance and confidence workplace participants place on their JOHSC. 

If you are just starting a committee or looking for ways to improve its effectiveness,  WorkSafeBC offers a Joint Occupational Health and Safety Committee Foundation Workbook.  The workbook is full of resources and space for committee members to develop and improve the operations of their committee.  

Do Joint Health and Safety Committees make a difference?

A learner in a class discussion I was moderating asked a simple question about Joint Health and Safety Committees:  do they make a difference?

A recent  systematic review summarized the best evidence to date this way:

It can be concluded that there is consensus in the research literature on the value of effective Joint (worker‐employer) Health and Safety Committees (JHSCs). 

Note two important words in that conclusion: “effective” and “joint”. 

I have seen firms argue that they have a health and safety committee because they put health and safety on staff-meeting agendas or ask if there are any health and safety issues after a regular safety meeting.   These are not safety committees.  I have also been told by a firm’s safety officer that their safety committee is joint but all the decisions are actually made when the department heads sit down at their operational meetings.

Real JHSCs are joint, with representation from workers and management.  How many members do you need?  Some jurisdictions spell that out with prescribed numbers of representatives, typically equal numbers of management and labour (often with representatives from each union at a common worksite).   Real JHSCs have empowered representative members with the knowledge, training, and access to information they need to carry out their responsibilities.   

Most jurisdictions mandate the existence of JHSC although the name of the committee, duties of members and provisions for training members may vary.  Joint Health and Safety Committee is the official title in BC, Ontario, New Brunswick, and Yukon.  Alberta,   Northwest Territories, and Nunavut use  Joint Work Site Health and Safety Committee.   Nova Scotia and PEI call them Joint Occupational Health and Safety Committees.   These are the most common variations in committee names.  The names are important if you are trying to access data about requirements or benchmark performance across jurisdictions. 

All Canadian jurisdictions mandate the existence of JHSCs to some degree.  All jurisdictions define the conditions that require JHSCs creation; Alberta is alone in mandating specific work sites to have Joint Work Site Health and Safety Committees by Ministerial Order.  Currently, about two dozen (mostly very large) firms are designated by the Minister.  In reality, however, most medium to large firms voluntarily establish JHSCs because that’s accepted best practices in most industries.

Mandating the existence of a JSHC is not the same as mandating its effectiveness.   A focus on reducing injury rate and days lost may be goals the JSHC can contribute to but measuring effectiveness requires acceptance of a logic mode.  For JSHCs, that model is simply this:  The potential active and passive pathways through which workplace hazards can harm workers can be predicted, detected,  identified and interrupted by appropriate actions, safeguards and defenses.  Leading indicators such as frequency of risk identification (near miss reports, for example), percentage of staff members who access and read JHSC minutes (easy to track on an intranet),  and percentage of JHSC action items completed are a few measures JHSCs have used to gauge their own effectiveness. 

The minutes of a JHSC can be an important means of hazard identification, risk mitigation, and even cultural change.  Only WorkSafe New Brunswick requires committee minutes be submitted to them.  In years gone by, the idea of thousands of committee minutes arriving in a mailroom would dissuade most policy makers from making submission a routine requirement.  In an age where electronic systems are capable of not only receiving and storing large but also reading and validating massive volumes of data, that objection is fading fast; at the same time,  the advantages of electronic submission and analysis of JHSC minutes are growing  Such a data repository could be the next big asset in prevention.   In the meantime, a mandate for submission of committee minutes may provide an impetus to improving their effectiveness. 

So, JHSCs exist or are required to exist in most workplaces and the literature confirms that effective JSHCs are valuable.  As a worker, employer, or JSHC member why not make “improving the effectiveness of our joint health and safety committee” a new year’s resolution?  The evidence suggests having an effective JSHC can and will make a difference.  

Can a toxic workplace harm workers?

Most of us have heard of “toxic” workplaces.  The hallmarks of a toxic workplace typically include discrimination, back-biting, rumor-mongering, obsessive favoritism, repeated harassment, bullying and more.  As a result, workers may experience anxiety, become depressed, take sick leave or leave the company altogether.  Notice, the characteristics of a toxic workplace are all about behavior not intent. Regardless of the intent,  there is now compelling evidence that such behaviors by superiors and co-workers can harm and are harming workers.

Increasingly, workers’ compensation systems are accepting mental or psychological injuries arising from the work environment.  The trend is a natural consequence of research that has shown how stressors in the workplace can increase the risk to the psychological health of workers even in the absence of any physical trauma.  

Workers’ compensation systems have a long history of accepting psychological injury as a consequence of physical trauma.  Post-traumatic Stress Disorder (PTSD) is perhaps the highest profile diagnosis but clinical depression and anxiety are common and can become chronic sequellae to traumatic injury.  A single traumatic event without personal physical injury has also been recognized as creating a risk of psychological injury to workers.  First responders, disaster relief workers, and worker-witnesses to traumatic events are certainly at risk of mental disorders. 

What we now know from the research is that serious psychological harm in the form of mental disorders can occur from a single traumatic event or a cumulative series of significant stressors in multiple work-related events.  While the standard (and onus) of proof required for the acceptance of mental disorder claims varies across jurisdictions (from “causative significance” to “predominant cause”), the recognition of the risk puts an onus on employers and workers to take action to protect workers and stop behaviors like workplace bullying and harassment .  Failure to do so may well constitute a breach of the employer’s general duty to take all reasonable steps in the circumstances to ensure the health and safety of workers.

In BC, changes to the Workers Compensation Act recognized the evidence on mental injuries and the connection to toxic workplace behaviors such as bullying and harassment.  Prior to the changes contained in Bill 14, compensation was payable only where the mental stress was an acute reaction to a sudden and unexpected traumatic event arising out of and in the course of employment.  Under the changes that came into effect on July 1, 2012 “mental disorder” is recognized as a reaction to one or more traumatic events arising out of and in the course of the worker’s employment.    The amendment recognized that a diagnosed mental disorder may arise from a significant work-related stressor or a cumulative series of significant work-related stressors.

It’s more than a year down the road since the effective date in BC.  From published data and presentations we know that 3000 claims have been registered since July 1, 2012.  So far, nearly 500 claims have been allowed while 1400 have been disallowed or rejected and others have been suspended until a worker agrees to be diagnosed by a psychiatrist or psychologist. 

Not every work-related stressor causes a work-related injury.  The pressure of workloads and deadlines, the realities of labour force adjustments and the inevitable changes in job duties are intrinsic to many industries and work environment.  While the Bill 14 amendments prescribes some exclusions (such as discipline, termination and changes in the work to be performed or in working conditions), mental disorders that are a consequence of bullying and harassment are clearly within the scope   of coverage. 

The main objection to inclusion of mental disorders in the scope of coverage and instituting new policies that target bullying and harassment involves intentions.  I’ve heard a few employers say, “It’s not my intention to harass anyone…”, “I like to keep my employees off balance—it makes it easier to manage them” ,  “Sure I am hard on my staff but it is for the benefit of the team—we all win if we meet the deadline”, “I’m not harassing any one person… It’s not harassment if you treat everyone the same.”   Even if you think there might be some merit to any of the intentions, what really matters to workers are the behaviors they observe and experience. 

Behaviors  such as calling an employee in for a meeting without ever telling them in advance why , micromanaging, withholding critical information necessary to do one’s job, and playing one employee off another may be seen as ways to retain power, meet deadlines or exceed production quotas  but are really passive-aggressive behaviors that can increase the toxicity of a workplace.  

Physically beating subordinates is never justifiable to meet deadlines or production quotas; should behaviors that can inflict mental harm be treated any differently?  Clearly, the ends in either case do not justify the means. Behaviors, not intentions, are what workers observe and experience.  Not all the behaviors mentioned here are captured by the formal definition of bullying and harassment, but they are behaviors that can undermine confidence, heighten anxiety, foster depression and contribute to a toxic workplace. 

Not every worker who is bullied or harassed will develop a mental disorder;  that does not mean that the harassment and bullying can go on with impunity.  WorkSafeBC’s policies pursuant to the Occupational Health & Safety Regulation came into effect on November 1, 2013.  The policies define bullying and harassment; more importantly, they explain the duties of workers, employers, and supervisors to prevent and address workplace bullying and harassment.

No regulatory prohibition can eliminate all the characteristics of a toxic workplace.  Eliminating bullying and harassment is a good place to start.   

Is age 70 or 75 becoming the new 65?

I was in Washington, DC last week speaking on the impact demographic change is having and will continue to have on workplaces.  After the “Global Economic Crisis” and severe recessions in many countries, there is evidence that workers delaying retirement and even re-entering the labour force.  Demographic changes is also having an impact on the supply of qualified younger workers to take the place of older workers poised to exit the labour force. 

In preparing my remarks I came across a blog post by Alicia H. Munnell  on The Wall Street Journal’s Market Watch site entitled, “Social Security’s real retirement age is 70” [October 23, 2013].  She writes:

Social Security’s retirement age is 70.  The simple fact is that monthly benefits are highest at age 70 and are reduced actuarially for each year they are claimed before age 70.  This is a relatively new development, which may explain why Social Security’s retirement age is the best-kept secret in town.  But I think it’s time we told folks.   And then we need to clarify what all this talk about raising the so-called full retirement age really means.

US Social Security and the Canada Pension Plan (CPP) are similar in many ways.  CPP also provides the greatest benefit to those who postpone receipt to age 70. Yes, 65 is still the reference year for retirement but waiting has its rewards and these are increasing.   From 2011 to 2013, the Government of Canada has gradually increased the incentive to delay collecting CPP.  As of this year, 2013, if you start receiving your CPP pension at the age of 70, your pension amount will be 42% more than it would have been if you had taken it at 65. 

Put another way, if you assume the point of view of age 70 as the reference year at 100%, then retirement at age 65 has an initial monthly CPP payment of only 70.4% of the monthly amount at age 70.  Because CPP is also increasing the “penalties” for retiring early, in 2013, a 60 year old retiree would get only 47.6% of the retiree delaying receipt of CPP to age 70. 

Now, for many people the incentive or penalty is irrelevant.  Health and income may simply make delaying receipt of CPP out of the question.  For others, particularly those that are in relatively good health and who may have invested heavily in education before starting work, work beyond age 65 may be a necessity.  The employment rate of for males 65 and over with a university degree was 25.3% in 2012.  For those 65 and older with educational attainment above a bachelor’s degree, the employment rate was nearly 30% in that year.  Both the employment rate and actual numbers of these older workers is increasing.  [CNSIM Table 282-0004 Canada, Employment rate by Educational Attainment for selected age groups 2012].

Canada and the US are well above the OECD average for life expectancy.  The life expectancy and labour force participation rate for those over the age of 65 are also above average-- and rising-- but still below  life expectancy and participation rates in some countries such as Sweden.  Sweden’s centre-right  Prime Minister,  Fredrik Reinfeldt , recently put it bluntly:  Swedes should be prepared to work until they are 75 and to change careers in the middle of their work life if they are to keep the welfare standards they expect.  He also note that half of today's children in Sweden can expect to become 100 years old and there has to be a change in the way the Swedes view their work life.

The point is simply this:  we are seeing and will continue to see more workers aged 60, 70 and older in our workplaces.  We need them.  Work is good for their health and well-being.  They want to work –some for the money but many for social and mental stimulation reasons.   It is time to rethink policies and attitudes that fail to appreciate this changing reality.  

Why did you attend the ACHRF event in Australia?

I spent much of October in Australia.  My main purpose was to attend the third Australasian Compensation Health Research Forum (ACHRF) in Sydney.  The forum had two full days of presentations and discussions along two themes:  Day 1-  Return to work and social participation and Day 2- Health and disability services delivery.  While there is no substitute for personal participation in the conference, the organizers have made most presentations available on line.

My keynote presentation was an introduction to the first day and to the theme of return to work and social participation.  I used an “environmental scanning” approach to highlight “Six Trends, Three Predictions and One Sure Thing: International Perspectives on Return to Work and Social Participation.” This presentation provided evidence for six trends in North America, Europe and the Australasian region and some predictions for what is coming next. 

I touched on the following trends:

1.       Rise of social enterprise 
2.       Mainstreaming Social Responsibility
3.       Enabling through Technology
4.       Improving through Comparison
5.       Dawning of BIG DATA
6.       Resetting Expectations

My three predictions that will influence RTW in the future flowed from these trends and from other developments that are hard to ignore:

1.       Demographic Change:  Unexpected Consequences
2.       Concepts of “Disability” will change….Dramatically
3.       Technology, for good and ill, will change everything

The “One Sure Thing” is that the number of disabled persons is going to increase dramatically.  Already, US Social Security Disability is nearing the point of insolvency; the number of recipients of Canada Pension Plan Disability is rising and is projected to continue to rise for at least the next two decades.  This does not even address the rising prevalence of disability in the overall population.  One New Zealand study projects the disabled population is estimated to grow over the next 50 years to 1.2 million people, or 21 per cent of the total population.

The goal of the presentation was not to solve the world’s problems or to pass judgment on the trends identified.  The goal was to invite the gathered researchers, administrators, policy makers and practitioners to lift their point of view from the narrow focus on jurisdiction and caseloads; to view the wider world of RTW and social participation in other jurisdictions; and to begin a process of discussion, research and action to improve outcomes for those that need it most.

A major advantage of participating in this event was the opportunity it afforded me to meet with reprentatives from agencies that share the mandate of WorkSafeBC.  These included WorkSafe Victoria, the Transport Accident Commission (TAC),  ACC,  Comcare, WorkCover NSW and many researchers associated with the Institute for Safety and Compensation Recovery Research (ISCRR)— host of the event and sponsor of my participation.  Those informal discussions provide the context essential to understanding the trends and results evident in other jurisdictions. 

Even if you can’t personally attend events like this one, the program and presentations provide a portal through which you may glimpse the direction of new research and the approaches of others to issues common to all.   The world of workers’ compensation, prevention, and RTW is small and many of the challenges we face are common.  There is much to learn from each other.  Exploring the presentations from this event may open new avenues of dialogue with our Australasian cousins.