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01-12-2011

The Role of Health Care Providers in Long Term and Complicated Workers’ Compensation Claims

Authors: Agnieszka Kosny, Ellen MacEachen, Sue Ferrier, Lori Chambers

Published in: Journal of Occupational Rehabilitation | Issue 4/2011

Abstract

Introduction: Health care providers (HCPs) play a central role in workers’ compensation systems. In most systems, they are involved in the legitimization of work-related injury, are required to provide information to workers’ compensation boards about the nature and extent of the injury, give recommendations about return-to-work capability and provide treatment for injury or illness. This study identifies problems that occur at the interface between the health care system, injured workers, and workers’ compensation boards (WCBs) that may complicate and extend workers’ compensation claims and the mechanisms that underlie the development of these problems. Methods: Interviews were sought with injured workers, peer helpers and service providers from a variety of geographic locations in order to get a broad picture of return to work problems and concerns. This analysis includes data from total of 34 interviews with injured workers who had long term and complicated claims. Interviews were also conducted with 14 peer helpers and 21 service providers. Results: We identified four domains related to injured workers’ interface with the health care system that played a key role in complicating and prolonging compensation claims. These problems, related to health care access, conflicting or imperfect medical knowledge, limited understanding of compensation system requirements and confusion about decision-making authority, resulted in frustration, financial difficulties and mental health problems for injured workers. Conclusion: Recommendations are made about how compensation system parties can find better ways to serve injured worker health care needs and facilitate a smooth relationship between the compensation board and HCPs.

In Ontario a physician, chiropractor or physiotherapist can be an injured worker’s primary health care provider. In their study examining the effect of health care provider communication on return to work, Kosny et al. [25] found that 75% of studied workers had a physician as their main health care provider.

After this study was completed the terminology changed at the Ontario Workplace Safety and Insurance Board. The term ‘adjudicator’ was replaced by ‘case manager’. In this paper we have used the term ‘adjudicator’ for congruence with the participants’ own language in the quotes.

All names are pseudonyms.

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Title: The Role of Health Care Providers in Long Term and Complicated Workers’ Compensation Claims
Authors: Agnieszka Kosny
Ellen MacEachen
Sue Ferrier
Lori Chambers
Publication date: 01-12-2011
Publisher: Springer US
Published in: Journal of Occupational Rehabilitation / Issue 4/2011
Print ISSN: 1053-0487
Electronic ISSN: 1573-3688
DOI: https://doi.org/10.1007/s10926-011-9307-3

At a glance: The STEP trials

Springer Medicine

The Role of Health Care Providers in Long Term and Complicated Workers’ Compensation Claims

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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