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Purpose: The objective of this study was to explore how workers’ compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers’ compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. Results: We identified two main themes: (1) Shaping HCPs’ clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP’s behaviours with workers; (2) Controlling workers’ trajectories of care. This theme presents how WC policies achieve control of the workers’ trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP’s day-to-day practices and workers’ trajectories. A better understanding and a nuanced portrait of these policies’ impacts can help support reflections on future policy changes and inform policy development in other jurisdictions. more...

This article reports on a study of occupational health and safety (OHS) challenges for temporary foreign workers (TFWs) in low- and high-skilled occupations, based on twenty-two cases drawn from a broader study in three Canadian provinces. Interviewees in construction, meat processing, hospitality, and fast food reported concerns regarding working conditions and OHS issues. They include precarious migration status affecting voice; contrasting access to social support; and mechanisms undermining regulatory effectiveness. Sources of vulnerability include closed work permits (making workers dependent on a single employer for job security and family reunification); ineffective means to ensure contractual compliance; and TFW invisibility attributable to their dispersal throughout the labor market. Violations include increased workload without an increase in pay and non-compliance with OHS and contractual rules without oversight. Positive and negative practices are discussed. Recommendations include improving migration security to preserve worker voice and facilitating communication between immigration and OHS authorities. more...

Purpose Work injury and return to work processes can have adverse effects on injured workers and their families. Family members may experience increased workloads, role reversals, dissolution of marriages or changes in relationships with children, as well as financial strain from loss of income. How these associations interact when the injured worker is precariously employed, however, is unknown. The aim of this study was to explore the impacts of work-related injury or illness as well as subsequent compensation and return to work processes on families and relationships of precariously employed workers. Methods Interviews were conducted with fifteen precariously employed injured workers recruited through on-line advertising, injured worker groups, and social media platforms in Ontario. Situational analysis was used to identify how family members were affected and their role throughout the injury process. Results Precariously employed injured workers felt caught between self-interested employers and disinterested workers' compensation. In some cases, this led to deteriorated mental health and well-being. The worker's difficulties with RTW challenged financial security of families and affected their day-to-day normal routines. While some workers received emotional and instrumental support from their family members, others had their families fall apart when chronic disability and unemployment proved to be too much. Conclusions This study addressed the complex ways that work injury and illness among precariously employed workers interact with family life and relationships. Findings illustrate how the income and employment insecurity associated with precarious employment has ripple effects on workers and their families when they become injured. more...

Background First-line health care providers are the primary access point for workers' benefits. However, little is known about their impact on quality of care and return-to-work. Our objective was to critically compare literature on the practices of first-line providers for workers with musculoskeletal injuries in Ontario and Quebec (Canada), Washington State (United States), and Victoria (Australia). Methods A critical interpretive synthesis of peer-reviewed scientific literature was conducted. The search across six databases yielded 59 relevant publications that were critically appraised. Results Three themes emerged: 1) how policies about first-line health care providers' modulate worker access to care, 2) how these providers' roles, practices, and training shape disability management, and 3) how the quality of care and disability outcomes are evaluated. Conclusions First-line health care providers have a critical influence on workers' trajectories of care. A focus on their role while taking the complexity of the context into account will help orient future policy changes. more...

INTRODUCTION It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury. METHODS Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta. RESULTS Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40). CONCLUSION Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days. more...

The policies and practices of workers’ compensation have barely kept pace with the changing worker and employer needs created by the growth of precarious forms of employment. This study focused on how well workers’ compensation and RTW policies in Ontario fit the needs of precariously employed workers. A critical discourse analysis guided our study which consisted of in-depth interviews with 15 precariously-employed workers and 5 employers who had hired and managed these kinds of workers. Three domains where RTW policies fit uneasily with the experiences of precariously-employed workers were identified. These related to knowledge and power contrasts between well-informed employers and vulnerable workers, injury attribution challenges, and worker fear of speaking up about accidents. This study suggests that workers’ compensation and RTW policies rest uneasily with the circumstances of precariously-employed workers. In particular, it was difficult for workers to engage with/make a claim for workers’ compensation when employers resisted this process. Les politiques et pratiques concernant l’indemnisation des victimes de lésions professionnelles n’ont pas suivi le rythme des besoins changeants des travailleurs et employeurs résultant de la croissance de l’emploi précaire. Dans cette étude, nous avons cherché à savoir si les politiques concernant l’indemnisation et le retour au travail répondaient aux besoins des travailleurs ontariens qui occupent un emploi précaire. Une analyse critique du discours a guidé l’étude, qui a consisté en entrevues en profondeur menées auprès de quinze travailleurs occupant un emploi précaire et de cinq employeurs qui ont embauché et dirigé ce genre de travailleurs. Nous avons identifié trois domaines pour lesquels les politiques de retour au travail ne sont pas en adéquation avec les besoins des travailleurs précaires. Il s’agit de l’écart en matière de connaissances et de pouvoir entre les employeurs bien informés et les travailleurs vulnérables, des défis liés à l’attribution des blessures et de la crainte des travailleurs à parler ouvertement de leurs accidents de travail. Les résultats de cette étude indiquent que les politiques d’indemnisation et de retour au travail ne sont pas en adéquation avec les besoins des travailleurs occupant un emploi précaire. En particulier, nous avons observé qu’il était difficile pour eux de faire une demande d’indemnisation quand les employeurs montraient une certaine résistance en cours de processus. more...

Michael Quinlan’s pioneering research on occupational health and safety (OHS) and workers’ compensation protections for the precariously employed inspired a generation of researchers both in Australia and internationally. This chapter documents strengths and weaknesses of OHS regulatory protections that are in force in various countries, focusing on their application to precariously employed workers. This includes those employed on temporary or part-time contracts, those working on-call and those working for sub-contractors or labour hire firms, either as employees or solo self-employed. Looking at both the regulatory effectiveness of legislation governing health and safety that is designed to prevent injury, and compensation for work-related injury and disease, including return to work provisions, this chapter will draw on the OHS literature, on studies conducted by the authors, and on legal cases involving expert testimony of Annie Thebaud-Mony that was based on Quinlan’s research findings, to illustrate the consequences of failure to consider the precariously employed when crafting regulatory provisions in the field of OHS. more...

French Abstract: Apres un rappel des consignes tires de la litterature scientifique relative a la prevention de la chronicite des incapacites developpees en raison d’une lesion professionnelle, ce chapitre examine certaines forces et faiblesses du regime quebecois de reparation a cet egard. Nous examinons differents elements de la Loi sur les accidents du travail et les maladies professionnelles et des pratiques dans ce domaine qui peuvent servir soit a prevenir ou a aggraver une incapacite chronique au travail. On s’attarde notamment sur les questions suivantes a la lumiere de la litterature scientifique reliee au retour au travail : L’evolution des connaissances scientifiques portant sur les bonnes pratiques pour prevenir les incapacites chroniques; la mesure du retour au travail dans les etudes scientifiques; les effets des perceptions d’injustice sur la sante et la readaptation; la mesure du stress relie au processus d’indemnisation. On examine ensuite, en tenant compte de resultats de recherche empirique, trois thematiques juridiques : l’assignation temporaire et le role des medecins dans le processus de reparation; la judiciarisation qui mene a l’inaptitude permanente; les reclamations pour lesion psychologiques chez les premiers repondants. On conclut en invitant l’ensemble des acteurs impliques dans le processus de reparation d’une lesion professionnelle a reflechir a toutes les sources potentielles de perceptions d’injustice afin de reduire en amont les facteurs qui menent a l’incapacite au travail. English Abstract: We first review the scientific literature on work disability prevention in the context of work-related disability and then examine the strengths and weaknesses of Quebec workers’ compensation legislation and of the practices associated with its implementation that can either prevent long term disability or contribute to prolonging disability. We focus on the following questions contextualized in the scientific literature on return to work: recent developments in scientific literature relating to the prevention of chronic disability; issues related to measurement of return to work; the effects of perceptions of injustice on the worker’s health and rehabilitation; scientific measures of “compensation stress”. We then turn to three legal themes: protective reassignment of workers prior to maximum medical recovery and the role of doctors in the process; adversarial confrontations in the compensation process that lead to permanent disability; claims for post-traumatic stress disorder filed by first responders. We conclude by inviting all players involved in the compensation system to reflect on the potential sources of workers’ perceptions of injustice in order to reduce the process-based factors that lead to disability. more...

Although much research has examined the occupational health and safety (OHS) and workers’ compensation (WC) implications of precarious employment and temporary international labor migration, little is known about the implications of diverse types of employment-related geographic mobility for regulatory effectiveness of OHS and WC. This article examines different types of extended mobility to determine regulatory effectiveness of OHS and WC protections. Based on classic legal analysis in seven Canadian jurisdictions, and interviews with key informants, we found that the invisibility of the internally mobile workforce, as well as the alternating visibility and invisibility of temporary foreign workers, contribute to reduced effectiveness of the OHS and WC regulation. Results point to the need for better protections to address working conditions, but also the hazards and challenges associated with mobility itself including getting to and from work, living at work, and maintaining work–life balance while living at the worksite. more...

Globally, employment-related geographical mobility (mobility to and within work) is a pervasive aspect of work that has potential health and safety implications. As an introduction to this special issue, this article defines the mobile workforce as those who engage in complex/extended mobility to and within work encompassing >two hours daily, less frequent but more extended mobility between regions and countries, and mobility within work such as between work sites or in mobile workplaces. Focusing on the Canadian context, we discuss the challenges associated with developing a statistical profile for this diversely mobile workforce and provide an overview of articles in the special issue identifying key health and safety challenges associated with extended/complex employment-related geographical mobility. We estimate that up to 16 percent of Canada’s employed labor force (including those commuting > one hour one-way, temporary residents with work permits, and transportation workers) engage in extended/complex mobility related to work. more...

Seafaring involves multiple patterns of mobility. Ships are mobile workplaces that connect and disconnect from land. Many move within and between national boundaries. Maritime labor forces are recruited from multiple locations engaging in varying commutes to and from homeports—international commutes for international labor forces and internal commutes for national labor forces. Mobilities expose seafarers to a range of occupational health and safety hazards, which can be exacerbated by mobility-related constraints on regulatory protections. Based on legal analysis and twenty-five semi-structured interviews with Canadian seafarers, managers, and key informants, this exploratory study examines how employment-related geographical mobility may create occupational health and safety challenges for Canadian seafarers working on the Great Lakes and the St. Lawrence Seaway. Findings show that few legal instruments are available to protect seafarers from commuting-related occupational hazards and that occupational health and safety challenges are numerous. Seafarers’ occupational health and safety rights on board are restricted and they are systemically discouraged from raising safety concerns. more...

Background This study sought to identify impacts of compensation system characteristics on doctors in Quebec and Ontario. Methods (i) Legal analysis; (ii) Qualitative methods applied to documentation and individual and group interviews with doctors (34) and other system participants (31); and (iii) Inter-jurisdictional transdisciplinary analysis involving cross-disciplinary comparative and integrative analysis of policy contexts, qualitative data, and the relationship between the two. Results In both jurisdictions the compensation board controlled decisions on work-relatedness and doctors perceived the bureaucratic process negatively. Gatekeeping roles differed between jurisdictions both in initial adjudication and in dispute processes. Quebec legislation gives greater weight to the opinion of the treating physician. These differences affected doctors’ experiences. Conclusions Policy-makers should contextualize the sources of the “evidence” they rely on from intervention research because findings may reflect a system rather than an intervention effect. Researchers should consider policy contexts to both adequately design a study and interpret their results. Am. J. Ind. Med. © 2016 Wiley Periodicals, Inc. more...

This paper presents results of a Canadian study looking at workers’ compensation regulatory frameworks, designed to optimise return to work outcomes, as applied to precariously employed workers. Comparing frameworks in the two Canadian provinces of Quebec and Ontario we find that in both provinces the quality and nature of incentives placed on employers and insurers to return workers to their maximum earning capacity is largely driven by their earnings at the time of injury, while the nature of the incentives placed on workers also varies depending on their earnings at the time of injury, but in different ways. Workers employed by temporary employment agencies are also disadvantaged because of the system design, regardless of their earnings. The disparity in incentives, particularly with regard to employers and insurers, leads to situations of systemic discrimination, whereby those whose work is undervalued at the time of injury, such as recent immigrants who are over-qualified for the positions they hold, receive minimalist support in return to work as compared to workers whose claims will be more costly for the system and the employer. Support is thus predicated on costs rather than potential employability or needs. Those in non-standard employment relationships are further undermined by the diffuse nature of responsibilities in return to work. The study relies on classic legal methodology combined with interview data drawn from interviews undertaken in 2016 and 2017 with workers, employers, and key informants, a mixed methods approach which allows us to identify the specific rules in each of the two systems that favour or undermine adequate support in reducing work disability. more...

Cet article présente les résultats d’une étude exploratoire sur l’accès aux services de santé des migrants à statut précaire. Une enquête a été menée auprès de 211 hommes et femmes migrants, et parmi ceux-ci, 31 ont été retenus pour un entretien en profondeur. Pour cet article, nous présentons les résultats concernant 78 travailleurs comprenant ceux recrutés en tant que travailleurs (travailleurs étrangers temporaires) ou qui n’ont pas d’accès au filet de sécurité sociale et doivent habituellement travailler (les sans-papiers). Une revue de la littérature est présentée, reliant le statut migratoire à l’accès aux soins de santé et aux problèmes de santé au travail. Nous présentons la méthodologie et ensuite les résultats qui décrivent les réseaux sociaux auxquels les travailleurs migrants ont recours pour répondre à leurs préoccupations en matière de santé, comprenant notamment les professionnels du Québec, et des ressources transnationales en santé. Ces résultats pourront être utiles aux professionnels de la SST pour comprendre certains obstacles auxquels font face les travailleurs migrants ayant subi un accident du travail ou une maladie professionnelle. Les difficultés d’accès aux soins de santé peuvent-elles compromettre le recours des travailleurs migrants victimes de lésions professionnelles ? The aim of this study was to analyze the temporal dimension of seasonal work and to identify determinants for the sustainable prevention of musculoskeletal disorders. An ergonomic work activity study with a gender-sensitive approach was conducted. Sixteen female seafood-processing workers were monitored for two consecutive work seasons using a range of interviews, observations (work activity, production, and organization) and document analyses. The results led to the development of methodological elements for the study of seasonal work. The results also showed that the work activity could be seriously influenced by determinants pertaining to public policies and ministerial rules. Sustainable prevention of musculoskeletal disorders must consider these determinants. Este artículo presenta los resultados de un estudio exploratorio sobre las experiencias de los migrantes de estatus precario cuando tratan de acceder a los servicios de salud. Se encuestaron a 211 hombres y mujeres inmigrantes y se hicieron 31 entrevistas semi-estructuradas de seguimiento. A los efectos de este artículo, se presenta los resultados de 78 encuestados que fueron reclutados, específicamente como trabajadores (trabajadores extranjeros temporales) o que no tienen acceso a la ayuda económica y que por ello deben probablemente estar trabajando (indocumentados). Comenzamos el artículo con un resumen de la literatura que vincula el estatus migratorio a un difícil acceso a los servicios de salud así como a un mayor riesgo de problemas de salud y seguridad ocupacional. Después de la presentación de los métodos, nos volvemos a los resultados, describiendo como los trabajadores migrantes utilizan una combinación de redes sociales, que comprenden profesionales de Quebec y recursos transnacionales en salud, para hacer frente a sus problemas de salud. Los resultados ofrecen información a los profesionales de salud y seguridad ocupacional que buscan entender las diferencias en cuanto a consecuencias para los migrantes que sufren accidentes o enfermedades laborales. ¿Puede el difícil acceso a los servicios médicos convertirse en un obstáculo para pleno uso de estos recursos de la parte de los trabajadores migrantes en casos de enfermedades o lesiones profesionales ? more...

Violence against women is notoriously pervasive and has been studied at length. Surprisingly less is known about the different facets of violence to which women are exposed at work. This article presents findings from a working paper commissioned by the Gender, Equality and Diversity Branch of the International Labour Organization to provide an overview of literature on occupational violence, from a broad range of disciplinary perspectives, including both conceptual papers and descriptions of regulatory frameworks from around the world. It first looks at definitions of workplace violence, including physical, psychological, sexual and discriminatory violence, including harassment, as well as workplace related intimate partner violence. It then turns to determinants of occupational violence, including psychosocial risk factors and structural violence. A discussion of the importance of using a gender lens to understand occupational violence and its roots concludes the conceptual section. Finally, the article presents different regulatory approaches to the prevention of occupational violence including both international and national instruments, again examined through a gender lens. It presents the case, in conclusion, for an integrated regulation of violence at work in order to maximize uptake of rights and effectiveness of prevention measures while promoting violence free workplaces for men and women. more...

Introduction In British Columbia, Canada, women have longer work disability durations for musculoskeletal injuries than men, even after adjustment for confounders. This study investigated if different types of health care utilisation in the first four weeks of injury explain differences in disability duration. Methods Three cohorts were identified from compensation claims for back strain, limb fractures and connective tissue injuries. Claims were restricted to at least four-weeks disability for a standard health care utilisation window. Quantile regression investigated the effect of physician visits (log count), physical therapies and prescriptions (yes/no), on disability days (censored at 365) at the 25 th , 50 th and 75 th percentile by gender. Results In multivariable models, physician visits were associated with shorter disability durations for both genders across injury cohorts. For example, for connective tissue injuries, an increase of one physician visit was associated with 44 fewer days [95% CI-64.8,–23.9] for women and 56 fewer days for men [−74.2,–37.5], at the 75 th percentile. Opiate prescriptions were associated with longer disability durations for factures only, with 39 more days [95% CI 16.1, 61.3] for women and 46 more days [32.1, 59.3] for men, at the 75 th percentile. The effect of physical therapies varied by injury and gender. Discussion Physician visits in the first weeks of a compensation claim may be part of return-to-work procedures associated with shorter disability. Opiate prescriptions in the first weeks of a fracture may be a measure of severity associated with longer disability. Health care utilisation did not readily explain longer disability durations for women. more...

Objectives. We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers’ compensation (WC). Methods. In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression. Results. Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized. Conclusions. The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation. more...

A comparative analysis of public policies on mental health at work suggests that laws to prevent occupational health problems are more likely to cover workers’ mental health when occupational injury programs include compensation for mental health problems.This chapter is divided into two sections. The first, based on data from Quebec, describes workers’ exposure to psychosocial risks and associated health problems, and outlines how the organizations responsible for compensation deal with workers’ compensation claims. The second part describes the workers’ compensation legal framework in Quebec that applies to claims for work-related mental health problems. The conclusion provides suggestions for ensuring better management of mental health problems attributable to work. more...

Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention (WDP) and return-to-work (RTW). However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility (CSR), social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences. more...

This special issue of Policy and Practice in Health and Safety stems from a symposium held at the University of Ottawa, Canada, on 24-25 October 2012 to mark the 20th anniversary of the Westray mine disaster. It brings together papers that focus on trends in corporate criminal liability in a variety of jurisdictions. In this introduction we provide context for the papers and present reasons why they should be of interest to occupational safety and health (OSH) professionals, regardless of their geographical provenance or disciplinary background. more...

This article reports on the results of an empirical study of working conditions including psychological harassment (workplace bullying) in the province of Quebec, Canada, the first North American jurisdiction to regulate psychological harassment in its labor legislation. All empirical data provided in this article was drawn from the Quebec Survey on Working, Employment and Occupational Health and Safety Conditions, conducted through 5071 telephone interviews of a representative sample of Quebec workers, including the self-employed. Here we focus on employees, and provide bivariate and multivariate analyses. All analyses were stratified by gender. We provide a portrait of exposure to psychological harassment, and exposure to other psychosocial factors in the workplace associated with exposure to psychological harassment. Results show associations between exposure to psychological harassment and negative health measures including psychological distress, symptoms of depression, traumatic work accidents, musculoskeletal disorders and negative perception of health status. We report on steps taken by employees to put an end to the harassment. Gender similarities and differences in exposure, associated risk factors, health measures and strategies are presented and discussed in light of the legal context in which the study took place. We conclude with recommendations for prevention strategies that take into consideration the gender composition of the workplace. more...

Cet article explore les pratiques juridiques et de gestion appliquées au Québec à l’égard des personnes atteintes d’incapacité de travail en raison d’une lésion professionnelle. Il débute par un examen des facteurs associés au succès du retour au travail rapportés dans la littérature des sciences de réadaptation, notamment les études sur la réinsertion précoce. Ensuite, il examine le droit régissant la réadaptation professionnelle, ainsi que son application par les employeurs et la Commission de la santé et de la sécurité du travail (CSST) à la lumière des principales conclusions de la littérature en ce qui concerne les facteurs qui facilitent le retour au travail et ceux qui y font obstacle. On conclut que le droit lui-même crée peu d’obstacles à la mise en œuvre d’un retour au travail réussi ; par contre, les pratiques de gestion et de traitement des litiges entourant la mise en œuvre de ce droit peuvent compromettre le succès du retour au travail des personnes ayant subi une lésion professionnelle. This article examines Québec legal and management practices regarding workers disabled due to a work-related injury. The article begins by reviewing key issues raised in the rehabilitation literature with regard to factors that favour a successful return to work after injury, including studies on early return to work. It then examines Québec workers’ rehabilitation legislation and its application by employers and the workers’ compensation board (CSST) in light of the key findings from the literature regarding facilitators and obstacles to a successful return to work. It concludes that while the legislation itself creates few obstacles for a successful return to work, current practices in the management and handling of cases involving the implementation of this law may diminish the chances of successful return to work for injured workers. Este artículo explora las prácticas jurídicas y de gestión aplicadas en Quebec, prácticas relacionadas a personas afectadas por una incapacidad para trabajar a consecuencia de una lesión profesional. El artículo se inicia con una evaluación de los factores asociados a una reincorporación exitosa, factores descritos dentro de la literatura en ciencias de la rehabilitación, especialmente en los estudios sobre la reincorporación temprana. A continuación, él examina el derecho que rige la readaptación profesional, así como su aplicación por los empleadores del Quebec y por la Comisión para la Salud y la Seguridad en el Trabajo del Quebec (CSST), a la luz de las principales conclusiones de la literatura en lo que concierne a los factores que facilitan el retorno al trabajo y aquellos que lo obstaculizan. Como conclusión se encuentra que el derecho por sí mismo crea pocos obstáculos para la puesta en marcha de una reincorporación exitosa al trabajo ; sin embargo, las practicas de gestión y el tratamiento de los litigios y litigantes que rodean esta puesta en marcha pueden comprometer el éxito del retorno al trabajo de las personas que han sufrido una lesión profesional. more...

Background Workers’ compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers. Methods An overview of the literature on characteristics and effects of workers’ compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation. Results The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers’ compensation: the links between a ‘‘no-fault’’ system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers’ compensation systems in Canada. Conclusion Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants. Am. J. Ind. Med. 55:519–536, 2012. 2012 Wiley Periodicals, Inc. more...

By putting a price on workplace health and linking this to costs incurred in individual businesses, experience-rating rules encourage employer ‘gaming’ — cost-reduction attempts that do not necessarily increase workplace safety. We argue that experience-rating rules, together with the rise of non-standard employment arrangements, have fostered the growth of the temporary work agency sector to which employers can outsource workplace injury risk.This study explored how temporary work agencies in Ontario, Canada carry out workplace injury prevention and return to work. We aimed to understand why these agencies would shoulder experience-rating costs when they cannot control the work environment. Focus groups and in-depth interviews were held with 64 participants between 2009 and 2011. Participants included low-wage agency workers, temporary work agencies, client employers and key informants. Legal and documentary data were also analysed.Our findings show how experience-rating rules create a market for... more...