Topical Seminar 6

Topical Seminar 6:
Justice in the Compensation System

Session chair(s): Renée-Louise Franche

Schedule Details

Tuesday September 30
15:45 - 17:30 Afternoon Concurrent Sessions (T O25 - T O38 and Seminar 6)
Topic: Sociopolitical issues
Room C

Seminar Objectives

There has been a growing interest in understanding the experience of perceived justice, or lack thereof, of injured workers in Workers’ Compensation Systems (WCS), and in understanding the impact of perceived justice on worker health and recovery, and on return-to-work outcomes, following a workplace injury. Until recently however, little systematic research had been conducted in this area. It is now becoming clear that justice-related appraisals can have a dramatic impact on the physical and emotional consequences of injury. The objective of this seminar is to summarize current knowledge on the topic of perceived justice with a special focus on the WCS, using multi-method data. The seminar will also seek to propose directions for future research and developments.

The seminar will begin by providing a state-of the-art update on the relation between perceived justice and recovery outcomes. Recognizing that for solid research to be conducted, solid measurements are needed, the second presenter will focus on measurement issues and will present a theoretically-based measure of perceived justice to be considered in addition to more commonly used measures. The third presentation will use a therapeutic jurisprudence framework to examine, from the standpoint of workers, the application of legal rules that can contribute to workers’ perception of injustice in WCS appeal tribunal decisions (Quebec 1998-2013). Finally, a qualitative study of the public response to a 2009 hostage-taking by a WCS worker will be presented to gain insight into potential communication factors impacting on perceived justice of the WCS. The seminar will end with an open panel of all presenters to respond to questions and comments from the audience, ranging from theoretical to applied issues, with the goal of moving the justice-related research and intervention implementation forward.

Presentation 1: The Negative Impact on Injury-Related Perceptions of Injustice on Recovery Outcomes

Presented by: Michael Sullivan

Authors

Sullivan, Michael1

  1. McGill University

Abstract

Background

Individuals suffering from chronic pain face multiple frustrations and losses for which blame is often externally ascribed. Accordingly, recent work indicates that musculoskeletal pain patients often perceive themselves as victims of injustice and that these perceptions are linked with poorer physical and psychological outcomes.

Methods

This presentation will address the conceptual and empirical basis of injury-related perceptions of injustice. The presentation will summarize the results of recent studies examining the prognostic values of injury-related perceptions of injustice in individuals who have sustained musculoskeletal injuries. Data will also be presented highlighting variables that might mediate the relation between perceived injustice and recovery outcomes.

Results

The results of recent studies indicate that perceptions of injustice are prospectively related to more severe pain, heightened emotional distress and more prolonged disability. The pattern of findings suggests that perceptions of injustice impede recovery from the physical and emotional sequelae of injury.

Conclusions

Although emerging research suggests that perceived injustices is a psychological risk factor for problematic recovery outcomes, current psychological interventions for pain and disability do not systematically address perceptions of injustice. The presentation will describe intervention approaches that might be useful in targeting perceptions of injustice that arise consequent to musculoskeletal injury.

Presentation 2: Perceived Justice of Compensation Process Scale

Presented by: Renee-Louise Franche

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Authors

Franche RL1,2,3, Severin CN4, Lee H4, Hogg-Johnson S4,5 , Hepburn CG6, Vidmar M4, MacEachen E4,5

  1. WorkSafe BC, Vancouver
  2. Simon Fraser University, Vancouver
  3. University of British Columbia, Vancouver
  4. Institute for Work & Health, Toronto
  5. University of Toronto, Toronto
  6. University of Lethbridge, Lethbridge, Canada

Abstract

Background

There has been a growing interest in understanding the experience of perceived justice, or lack thereof, of injured workers in Workers’ Compensation Systems, and to understand the impact of perceived justice on worker health and return-to-work outcomes. To conduct solid research on the topic, solid measures are required. The most widely known and used measure of perceived justice in the Workers’ Compensation System is the valid and reliable Injustice Experience Questionnaire (IEQ) developed by Sullivan and colleagues (Sullivan et al. 2008), which focuses on the psychological experience of perceived injustice as experienced in various contexts. The purpose of our study was to develop and validate a measure of perceived justice specific to the Workers’ Compensation process. The intended focus of our Perceived Justice of Compensation Process (PJCP) Scale was on the claim process of workers who are off work due to a workplace musculoskeletal (MSK) injury. The development of the PJCP Scale was based on the theoretical framework of organizational justice (Colquitt 2001; Corpanzano & Greenberg, 1997), which involves the four dimensions of Distributive Justice, Procedural Justice, Interpersonal Justice, and Informational Justice.

Methods

The study was conducted within the sampling frame of the Readiness for Return to Work (RTW) prospective cohort (Bültmann et al. 2007; Franche et al. 2007) of lost-time claimants with work-related back or upper extremity MSK disorders, recruited in cooperation with the Workplace Safety and Insurance Board (WSIB) of Ontario, Canada. Injured workers (n=446) participated in our study 6 months post-injury (retention rate of 71%). Workers were eligible to participate if they reported an absence from work of at least 5 days in the first 14 days following a workplace injury. Data were obtained from participant structured interviews and the WSIB administrative database. Routinely captured claim information, such as claim status, was extracted from the WSIB database and linked to the interview data when written consent for linkage was provided by the participant. When consent for linkage was not provided, the data was considered to be missing in analyses involving linkage. For analyses which did not involve linkage, such as descriptive statistics, the administrative data was reported for the full sample. Items from previous organizational justice measures (Colquitt 2001; Moorman 1991) and surveys of injured workers were reviewed by a group of researchers with expertise in occupational health. A pool of 19 items specific to each of the four justice dimensions was created: Distributive; Procedural; Interpersonal; and Informational. Items were adapted to the context of a RTW after a workplace injury and the group of researchers hypothesized a priori to which factor each created item would belong to. Exploratory and confirmatory factor analyses were conducted with two separate samples. Validation was explored by examining the psychometric properties of the scale with alpha coefficients and intercorrelations between subscales. Concurrent validity was examined and focused on the relationship between the PJCP Scale and the constructs of claim status, delays in claim processing, worker perception of the work accommodation process. Five hypotheses regarding concurrent validity were posited.

Results

Average time between injury date and baseline interview date was 29.6 days (SD=6.2). Average time between injury date and 6-month interview date was 178 days (SD=11.1). Exploratory factor analyses were first conducted and revealed a four-factor solution. Factor 1 (distributive justice) accounted for 78.5% of the variance. Factor 2 (procedural justice) accounted for 15.4% of the variance. Factor 3 (informational justice) accounted for 6.0% of the variance. Factor 4 (interpersonal justice) accounted for 3.7% of the variance. Total variance explained was, therefore, 96.3%. Three items did not meet criteria for saturation on one factor of 0.40 or higher and were removed from the scale. Importantly all remaining 15 items loaded on their appropriate a priori factor. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. Subscales were significantly intercorrelated (r=0.46 to r=0.75). Cronbach’s alphas for each subscale were high, ranging from 0.86 to 0. 92. Concurrent validity of the scale was supported by confirmation of the 5 a priori hypotheses: 1) Workers with denied claims reported significantly lower levels of procedural, distributive, and interpersonal justice of the compensation process compared to those with accepted claims, with these effects being more pronounced for procedural and distributive justice subscales. 2) Low distributive, procedural, interpersonal, and informational justice was significantly associated with having a longer delay from injury registration to claim status decision, with effects being stronger for procedural and interpersonal justice. 3) Half of the participants reported feeling they had gone back to work too soon. Feeling that one had returned to work too soon was significantly associated with lower scores on all four justice subscales. 4) Workers who reported that their work accommodation was too short also reported lower levels of perceived justice on all four subscales, with the most significant impact on the distributive and informational justice subscales. 5) Higher distributive and procedural justice was significantly associated with higher levels of satisfaction with the quality of the work accommodation.

Conclusions

Workers’ perception of the justice of the compensation process can now be measured with a psychometrically sound and theoretically based instrument, the PJCP Scale. Our findings support the internal validity and concurrent validity of the 15-item PJCP Scale as applied to lost-time injured workers with work-related MSK disorders. Evidence was found for the presence of four distinct factors. However, evidence for the construct discrimination of the four justice subscales was not as strong when considering concurrent validity results. The independence of justice subscales in other contexts is the focus of significant debate (Colquitt et al. 2001). In our study, the clear factorial structure of our scale, combined with the direct mapping of items to hypothesized a priori items lends support to the presence of four factors. As well, although concurrent validity results point to a similar pattern of relationships between the four subscales and considered outcomes, the hypothesized relationships are stronger than those which were not hypothesized. This suggests that the fours factors are distinct but may behave in very closely related ways. This PJCP Scale offers researchers the opportunity to focus on the perceived justice of the workers’ compensation claim process of injured workers. The IEQ and the PJCP seem to complement each other. While the IEQ’s (Sullivan et a. 2008) strength appears to be its focus on the psychological impact of perceived injustice on the worker, our PJCP Scale is focused on specific aspects of the claim process. Use of the PJCP Scale may increase the understanding of the origins of the perceived justice/injustice of worker’s compensation system, by drawing attention to these specific aspects such as its outcomes (Distributive), procedures and rules (Procedural), interactions with staff (Interpersonal), and type and timing of information given to workers (Informational). By being claim process focused, and by breaking down the process in is four “justice dimensions”, the PJCP Scale provides an applied perspective on the justice of the workers’ compensation system, and it can facilitate potential changes to be considered by policy-makers, compensation management, and other return-to-work stakeholders.

Presentation 3: Perceived injustice in injured workers: analysis of public responses to an injured worker who took Workers’ Compensation Board employees hostage

Presented by: Douglas P Gross

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Authors

Brown CA1, Bostick GP1, Lim J1, Gross DP1

  1. University of Alberta

Abstract

Background

Perceived injustice is frequently identified in injured workers’ experience, with consequences of perceived injustice ranging from a negative impact on pain perception to retaliatory, aggressive actions. In October 2009 a workers’ compensation claimant in Alberta took 8 people hostage, stating he did this because he was treated unfairly and had benefits terminated prematurely. Public response to this event, available through the social media channels of on-line postings to the national news organization, presented an opportunity to examine perceived injustice in a compensation context in a segment of the general public.

Methods

We performed a qualitative exploratory study of public comments posted on an online news website in response to the hostage taking. We extracted and examined 978 postings regarding the incident and selected 115 comments reflecting narratives of personal involvement with workers’ compensation for thematic analysis. The Workers' Compensation Board-Alberta (WCB) website was reviewed to verify the beliefs about WCB expressed by posters. A standardized assessment tool was used to determine the readability and accessibility of the WCB website. This helped us gain insight into potential communication barriers contributing to the information exchanged in the postings.

Results

Including injustice, six inter-related themes emerged: retribution, perceived systemic mistreatment, injustice, empathy, disbelief, and loss. The most frequent categories of belief expressed about retribution against WCB were: “I understand why he would do it, but I don’t condone violence”; “WCB pushes you to the edge-this could have been me”; and “It is no surprise, there is more to come”. The final category, “people commit suicide” reflects that violent reactions to perceived injustice are not unidirectional. Claimants react with self-directed violence as well. We found beliefs expressed regarding WCB were often factually inaccurate. WCB materials were rated of poor quality in the domains of Literacy Demand and Cultural Appropriateness, potentially explaining some misperceptions held.

Conclusions

Personal narratives indicated strong perceptions of injustice. The lack of accurate information about workers’ compensation expressed may have contributed to perceptions of injustice.

Presentation 4: Blaming workers in a no-fault system: a source of perceived injustice?

Presented by: Katherine Lippel

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Authors

Lippel K1

  1. University of Ottawa, Faculty of Law, Civil Law Section, Canada Research Chair in Occupational Health and Safety Law

Abstract

Background

Qualitative studies (Lippel, 1999, 2007; MacEachen et al, 2010) have explored the experiences of injured workers in order to better understand compensation systems’ health effects, and have shown that factors associated with the adversarial process, including stigma and power imbalance are sources of workers’ perceptions of negative health effects. Others have found an association between compensation and disability duration, but rarely examine the nature of the process or experiences of workers (Grant & Studdert, 2009). Studies that explored the measure of “compensation stress” found it to be associated with recovery, suggesting that its reduction could reduce disability (Grant et al 2014). While quantitative studies can document workers’ exposure to stress, understanding the mechanisms of the system that can trigger perceptions of injustice requires a detailed understanding of the system itself.

Methods

Methods: Using a therapeutic jurisprudence framework this study applies classic legal analysis of workers’ compensation appeal tribunal decisions from Québec (1998-2013) to examine, from the standpoint of workers (Eakin, 2010), the application of legal rules that can contribute to a worker’s perception of injustice. Legally relevant administrative appeal tribunal decisions on compensation claims for musculoskeletal disorders were chosen from the data bank of the Commission des lésions professionnelles.

Results

Results: An overview of the case law on all issues relating to a claim illustrates pitfalls confronting workers who apply for compensation. These include rules governing time limits for a claim, evidence required to prove diagnosis, work exposures, disability and work-relatedness. Practices illustrated by the case law show that while health care practitioners may try to encourage workers to stay at work, and to sustainably return to work after injury, workers may be at risk of losing access to compensation when disabled because they have sought to stay at work for as long as possible or return to work despite previously documented “functional limitations”.

Conclusions

Conclusions: While Québec’s workers’ compensation system is, in many respects, one of the most generous in Canada (Lippel, 2012), this analysis shows that adversarial practices generated by experience rating mechanisms designed to promote greater employer involvement in the management of workers’ compensation claims expose workers to contradictory messages and stigma. A holistic view of the application of rules intrinsic to a workers’ compensation system can provide useful information for policy makers to enable them to reduce situations of injustice/perceived injustice.