Total disability days in interprovincial and home‐province workers injured in Alberta, Canada: A mixed‐methods study with matched‐pair analysis of compensation data and participant interviews

Abstract

IntroductionWorkers moving between states or provinces to find employment are reported to take longer to return to work after the injury.MethodsThe Alberta Workers Compensation Board (WCB) identified all workers from four Canadian Atlantic provinces who sustained a work injury in Alberta resulting in greater than 5 total temporary disability days (TTDDays) from January 2015 to June 2017. Each was matched on sex, age, and injury date with an Alberta claimant also with greater than 5 TTDDays. WCB information extracted included employment, injury, cost and place of treatment, and modified work. Cox regression identified factors associated with TTDDays. Semi‐structured interviews were also undertaken.ResultsTwo‐hundred forty pairs were identified and 60 interviews completed. Those from the Atlantic provinces had more TTDDays (median 63 days) than Alberta (median 22 days) with an unadjusted hazard ratio (HR) 0.50 (95% confidence interval [CI], 0.42‐0.61). When adjusted for all factors, the HR moved closer to unity (HR = 0.62; 95% CI, 0.50‐0.76). Total health care costs were the strongest predictor, with modified work, injury type, and claim status also explanatory factors. Among the Atlantic workers, leaving Alberta for treatment was strongly related to a lower likelihood of ending wage replacement (HR = 0.45; 95% CI, 0.32‐0.62). Participants in the interview study emphasized the importance of returning to the family after injury and the financial difficulties of maintaining a second home with reduced income after the injury.ConclusionThe higher costs of wage replacement associated with extended time off work may be inherent to the practice of employing out‐of‐province workers for jobs for which there is a shortage of local labor.

Do differences in work disability duration by interjurisdictional claim status vary by industry and jurisdictional context?

“…Previous research found that out-of-province workers from Atlantic Canada working in AB were half as likely to transition off disability benefits than their matched within-province counterparts [7].…”

“…Previous research using claims data has shown that out-of-province workers are different to withinprovince workers in terms of their demographic, employment and injury characteristics [7]. In order to produce unbiased estimates of the effect of out-of-province status on work disability duration, a matching strategy was used to balance the two groups on observable characteristics.…”

“…This difference between was partially attenuated when accounting for individual-level characteristics and fully attenuated when accounting for whether treatment was received in the province of residence or AB. Interviews conducted with a sample of the out-of-province workers highlighted they faced when injured, including the financial strain of keeping two homes while on disability benefits, opportunities for appropriate modified work, and opportunities for receiving medical treatment in their province of residence [7].…”

“…In the United States, a study of low back pain claims for a private insurer found that workers who worked and resided in the same state had fewer disability days than those who did not [6]. In the Canadian province of Alberta, a study found that workers from the Atlantic provinces working in Alberta when injured were half as likely to transition off disability benefits than their Alberta counterparts but that this difference disappeared after accounting for where the worker received treatment [7].…”

Differences in workers' compensation claim rates for within‐province and out‐of‐province workers in British Columbia, Canada, 2010–2017

“…5 This may be due to there being limited or no data available to identify such workers but also because they make up a small number of workers and therefore a small number of potential workers' compensation claims. Although there are studies examining differences in work disability duration by interjurisdictional status in Canada, 9,10 and the United States, 11 to date, the only research on the risk of work-related injury or illness is limited to a select groups of out-of-province workers to the province of Alberta, Canada, 5 and health behaviors of fly-in, fly-out (FIFO) workers in Australia. 12 In Alberta, Canada, a combination of workers' compensation data and survey data has been used to show how workers from outside of the province are less likely to report injuries to the workers' compensation board and less likely to have accepted claims, even after adjusting for various individual and work characteristics.…”