Presentation T O33
T O33 (Oral Presentation):
Comparing work disability outcomes under two different compensation schemes
- Institute for Work & Health, Toronto, Canada
- University of Groningen, Groningen, The Netherlands
- WorkSafe BC, Vancouver, Canada
In a prior study using administrative claim data, we saw increasing duration of work disability by injury year among Ontario workers’ compensation claimants, and linked this to a change in compensation policy & practices in 1998. That study lacked baseline information on injury severity & prognosis. In this study, we compared the 1993 Early Claimant Cohort (ECC) and the 2005 Readiness to Return to Work (RRTW) cohort which had similar baseline data on severity and prognostic factors.
Common inclusion/exclusion criteria were established for comparability. Baseline attributes of worker, injury and workplace were compared using t-tests and chi-square tests to look for shifts in baseline prognosis. Self-report health outcomes and work status at one year were compared, adjusted for baseline factors via OLS and logistic regression models. Claim outcomes based on WSIB benefits were compared, adjusted for baseline using logistic, OLS and Cox PH regression models.
The RRTW had more baseline pain on average (mean 6.7 vs 5.5 out of 10, p<0.0001). RRTW participants reported better one-year pain (1.74 95%CI(1.40,2.08) points better on 10 point scale) and mental health (SF36 MCS 3.40 95%CI(2.19,4.62) points better on 100 point scale) than ECC participants after adjusting for age, gender and baseline health. Baseline offers of work accommodation were more prominent in the RRTW (58% vs 21%, p<0.0001), likely due to Workplace Safety Insurance Act section 40 “Duty to accommodate”. The RRTW participants were also more likely to have returned to work (adjusted OR 2.36 95%CI(1.03,5.43)) and had 25.9 fewer days (95%CI(15.5,36.3)) on 100% benefits in the 1st year of claim after adjusting for baseline. However, they also had more episodes of disability (mean 1.5 vs 1.3) and 24.8 more days on 100% benefits (95%CI(-1.5, 51.1) after the first year than ECC participants, even after adjusting for baseline factors.
Early claim and worker outcomes were better in the RRTW than in the ECC, but poorer after one year. The post one-year outcomes are most likely related to change in adjudicative practices and the structure of benefits, although a prognostic shift at baseline likely also played a role. Complex system changes led to complex changes in claim outcomes.
Tuesday September 30
15:45 - 17:30 Afternoon Concurrent Sessions (T O25 - T O38 and Seminar 6)
Session: Social Interventions for work disability