Workers describe the effect of the workers' compensation process on their health: A Québec study

Abstract

This article reports on a Canadian qualitative study designed to examine the workers' experience of the workers' compensation process and to look at the effects of the process on the physical and mental health of claimants. Eighty five in depth individual interviews of injured workers in Québec and six group interviews with workers and worker advocates from Québec, Ontario and British Columbia were analysed to determine the positive and negative impact on claimant health of various steps of the workers' compensation process and of behaviours of significant actors in that process. While superior access to health care and access to economic support both contributed to claimant well-being, various facets of the process undermined the mental health of workers, and in some cases, also had a negative impact on physical health. Primary characteristics of the process that influenced outcomes included stigmatization of injured workers and the significant power imbalance between the claimants and the other actors in the system; the effect of both these mechanisms was tempered by social support. The article describes how caseworkers, physicians, appeal tribunals, employers and compensation boards contribute to the positive or negative impacts on worker health and concludes with recommendations designed to promote the therapeutic aspects of workers' compensation and to curtail those facets that are harmful to worker health. It also has implications for researchers who wish to consider the role of lawyers or compensation in the development or prevention of disability.

Preserving workers' dignity in workers' compensation systems: An international perspective

“…Studies in Canada [Ison, 1986;Lippel, 1999;Beardwood et al, 2005;Eakin, 2005;Lippel, 2007;MacEachen et al, 2007aMacEachen et al, , 2010, Australia [Roberts-Yates, 2003;Sager and James, 2005], and the United States [Lax and Manetti, 2001;Strunin and Boden, 2004] have shown that many workers' compensation claimants report feeling stigmatized by the process, blamed for being an injured worker, and shunned by the community and healthcare professionals because of their status as an injured worker.…”

“…The adversarial nature of a system is thought to increase in systems that are highly experience rated [Ison, 1998;Pransky et al, 1999;Lippel, 2007;Quinlan et al, 2010]. Although appeals are only a small part of the adversarial process, an increase in appeals over the years can provide an indicator of the increasing adversarial nature of the system.…”

“…The same institution is responsible both for workers' compensation and occupational health and safety; experience rating, rather than rigorous occupational health and safety regulation is the primary deterrence strategy. A variety of system actors interviewed [Lippel, 2007] have noted an increase in contestation of claims since the 1990s, when emphasis on experience rating was accentuated. In an early study measuring the effect of increased experience rating in Québec [Thomason and Pozzebon, 2002] it was found to be associated with aggressive claims management practices, as well as prevention practices.…”

“…A Québec study [Lippel, 2007] identified three primary issues that explained many of the negative health consequences reported by the workers: stigma, imbalance of power and lack of social support. Workers, including some workers whose claims had been accepted without contestation, reported being ''treated like a criminal'' or feeling like David confronting Goliath.…”

Cubital Tunnel Syndrome Occurrence in Workers: A Review

“…The worker is subject to the power imbalance with the system, prolonged claims and appeals processes, medical reports being used out of context, and a general lack of knowledge about rights. Claims can be manipulated by ignoring or contesting diagnoses, using confusing jargon and legalistic communication, slow payments to non-preferred physician to discourage treatment [39][40][41][42][43][44][45][46][47][48][49][50][51].…”