THE UNIVERSITY OF WESTERN ONTARIO

1
2003

• THE UNIVERSITY OF WESTERN ONTARIO
• Department of Epidemiology and Biostatistics
• Francine Lortie-Monette, MD, MSc, CSPQ, MBA

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Workers Compensation in Ontario Workplace
Safety and Insurance Board (WSIB)
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Roles of Physicians

• Prevention
• Diagnosis
• Treatment/medical management
• Facilitating return to work
• Reporting

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WSIB/MOLTC Agreement

• Business continues to be conducted under an
  agreement that was reached in October 1990
  between the WSIB and MOH

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FILING A CLAIM WITH WSIB -
Once a claim has been filed, a practitioner who
has examined or treated the worker has a duty
to promptly disclose health-related information
WSIB may need for adjudication purposes.
Conversely, there is no legal obligation to
release information if the patient does not wish
to file a claim. _______ Section 37 (1) of
the Workplace and Insurance Act, 1997.
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FILING A CLAIM WITH WSIB

• For accidents on or after January 1, 1998,
  workers must file a claim for compensation
• within 6 months from the date of accident
• or
• in the case of occupational disease, 6 months
  from the date at which the worker learns that
  s/he suffers from the disease.

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Difficult!

• incomplete medical information
• poor communication
• F.D. frequently misunderstands WSIB/employer/emplo
  yee role

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Body Part Evidence for Causal Relationship between physical work factors and musculoskeletal disorders
Neck and Neck/Shoulder Repetition, Force, Posture
Elbow Force
Carpal Tunnel Syndrome Repetition, Force, Vibration
Hand/Wrist Tendinitis Repetition, Force, Vibration
Back Lifting/forceful movement Heavy physical work Awkward Posture Whole Body Vibration
Musculoskeletetal Disorders and Workplace
Factors. US Department of Health and Human
Services, Public Health Service, Centers for
Disease Control and Prevention, National
Institute or Occupational Safety and Health, July
1997.
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WSIB Statistics-2001(1)
Accidents registered 375,000 Allowed
74 Abandoned 16 Denied
3 Pending 6 Amalgamated
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• Need for specific, objective information
• objective medical findings
• treatment plans
• notification re precautions (ie?)

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RANGE OF MOTION TESTING

• Active and Passive
• Multiple Directions

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(No Transcript)
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RETURN-TO-WORK ISSUES

• Returning a patient to work after an absence due
  to sickness or injury is an issue that arises
  almost daily in any busy family practice.
• One of the main goals for treating an ill or
  injured individual is to restore the person, as
  much as possible, to their pre-injury level of
  function.
• Recovery is not linear. An experienced physician
  will have designed a treatment plan from the
  earliest days of the event, using the patients
  job demands as one of the treatment goals.
• Prolonged absence from ones normal roles,
  including absence from the workplace, may be
  detrimental to a persons mental, physical and
  social well-being.

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A FEW 1998 STATISTICS FROM WSIB

• 725 Claims allowed per day, 37 with time lost
  from work. The average duration of short-term
  disability benefits 57.7 calendar days.
• Of the 97,000 lost-time claims as of March 31
  (1997-1998)
• 94 were for musculoskeletal injuries (sprain,
  strain, fractures). Of these
• 30 were injuries of the back (including the
  neck)
• 24 were injuries of the upper extremities.
• 18 were injuries of the lower extremities.
• Benefits paid 2.2 billions.

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CONSEQUENCES OF AN ILLNESS OR INJURY

• The World Health Organization International
  Classification of Impairments, Disabilities, and
  Handicaps provide a framework for describing the
  consequences of an illness or injury
• Impairment (an organ-based concept) any loss or
  abnormality of psychological, physiological, or
  anatomical structure or function. Impairment is
  described according to the body organ or system,
  e.g. visual impairment (myopia, blindness),
  musculoskeletal impairment (knee instability,
  shoulder impingement) or respiratory impairment
  (loss of FVC or FEV1).
• Disability (a task-based concept) any
  restriction or lack of ability to perform an
  activity in the manner or within the range
  considered for a human being. Disability is
  described according to a specific task, posture,
  or work environment, e.g. difficulty with
  floor-to-waist lifting, prolonged sitting, or
  working in the cold.

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In the view of the CMA the OMA

• It is not the treating physician's responsibility
  or role to determine whether the patients
  condition meets the insurers definition of
  disability
• ie the justification for the patient to be off
  work
• especially as the physician is not aware of all
  jobs available in the workplace

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Injury/Illness Return To Work/FunctionA
Practical Guide for Physicians

• Prepared by the Physician Education Project in
  Workplace Health in conjunction with the OMA and
  the WSIB

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What is the Functional Abilities Form (FAF)?

• Highlights limitations
• Optional tool completed at the request of either
  of the workplace parties

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Who can complete the Form?

• This form can only be completed by a health
  professional who is treating the worker (ie a
  member of the College of Health Profession as
  defined in The Regulated Professions Act, 1991)
• Health professionals do not initiate this form.

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Functional Abilities Form

• The legislation requires physicians and other
  treating health professionals to complete the
  Functional Abilities form only if requested to do
  so by the worker or employer.
• Some workplaces may prefer to use a form designed
  for their specific environment. These workplaces
  are welcome to use their own from to gather
  functional abilities information but the WSIB
  does not pay health professionals for completing
  these variations.
• NO MEDICAL OR DIAGNOSTIC INFORMATION should be
  requested or provided in a workplace-specific
  functional abilities form.

WSIB information hotline [phone]
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The Functional Abilities Form
Employer Requests from the worker a copy of the Form 2647A and a copy of the workers consent allowing the health professional to release functional abilities information to the employer. May send a copy of the form and of the consent directly to the health professional.
Worker Having signed consent, brings a copy of it along with Form 2647A to the attending health professional. Asks the professional to complete the form.
Health Professional Completes the form, gives the employer the canary yellow copy, gives the worker the pink copy and sends the white copy to the WSIB. The white copy also serves as the professionals invoice for payments. The FAE form may be faxed.
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Physical Demands

• Material Handling
• Lifting
• Carrying
• Pushing
• Pulling

• Non-Material Handling
• Stand/sit/walk
• Stoop/kneel/crouch
• Reaching
• Fingering
• Handling
• Grasp / Pinch
• Tool Use

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Physical Demand Characteristics of Work
Physical Demand Characteristics of Work (Dictionary of Occupational Tiles, Vol. II, 4th Edition, Revised 1991) Physical Demand Characteristics of Work (Dictionary of Occupational Tiles, Vol. II, 4th Edition, Revised 1991) Physical Demand Characteristics of Work (Dictionary of Occupational Tiles, Vol. II, 4th Edition, Revised 1991) Physical Demand Characteristics of Work (Dictionary of Occupational Tiles, Vol. II, 4th Edition, Revised 1991) Physical Demand Characteristics of Work (Dictionary of Occupational Tiles, Vol. II, 4th Edition, Revised 1991)
PHYSICAL DEMAND LEVEL OCCASIONAL 0-33 OF WORKDAY FREQUENT 34-66 OF WORKDAY CONSTANT 67-100 OF WORKDAY TYPICAL ENERGY EXPENDITURE
Sedentary 1-10 lbs. Negligible Negligible 1.5-2.1 METS
Light 11-20 lbs. 1-10 lbs. Negligible 2.2-3.5 METS
Medium 21-50 lbs. 11-25 lbs. 1-10 lbs. 3.6-6.3 METS
Heavy 51-100 lbs. 26-50 lbs. 11-20 lbs. 6.4-7.5 METS
Very Heavy Over 100 lbs. Over 50 lbs. Over 20 lbs. Over 7.5 METS
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Material Handling Characteristics of Work (U.S.
Dept. of Labor D.O.T. 1996)

• Occasional (0 to 33 of the workday)
• 1 lift/carry every 15 min
• Frequent (34 to 66 of the workday)
• 1 rep every 5 min
• Constant (67 to 100 of the workday)
• gt1 rep every 5 min

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Non-Material Handling Characteristics of Work

• Occasional (0 to 33 of the workshift)
• 1-100 reps over 8hr
• Frequent (34 to 66 of the workshift)
• 100-500 reps over 8hr
• Constant (67 to 100 of the workshift)
• gt500 reps over 8hr

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Consistency of Effort Testing

• A combination of tests / no one indicator
• Kinesio-physical Approach
• Normal expectations ie Push gt pull, shoulder
  height values lt bench height abilities
• Consistency in testing of same variable with
  different tests
• Objective physiological responses to activity
• HR BP monitoring Clinical observations
• Static Coefficients of Variation (gt50 CV gt 15)
• Jamar Grip (Expected Bell Curve / CV)
• Controversial if solely used
• Caution-Ref. Shechtman, Journal Hand Therapy,
  July 2001

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Canadian Classification and Dictionary of
Occupations Definitions

• Sedentary
• Lifting 10 lbs maximum.
• Occasional lifting and/or carrying.
• Primarily sitting, with occasional walking or
  standing.
• Light
• Lifting 20 lbs maximum.
• Frequent lifting and/or carrying up to 10 lbs.
• May require significant standing or walking.
• May involve sitting with pushing and pulling of
  the arms and/or leg controls.

• Medium
• Lifting 50 lbs maximum.
• Frequent lifting and/or carrying up to 20 lbs.
• May involve sitting with pushing and pulling of
  the arms and/or leg controls.
• Heavy
• Lifting 100 lbs maximum.
• Frequent lifting and/or carrying up to 50 lbs.
• Very Heavy
• Occasional lifting in excess of 100 lbs.
• Frequent lifting and/or carrying in excess of 50
  lbs.

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OCCUPATIONAL Health Stressors

• Work monotony
• low job control
• mental stress
• perception about work
• lack of flexibility

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UE Specific Recommendations

• Ability / force level for sustained grip/pinch or
  torquing
• Job task rotations
• Comment on frequency of repetitions
• Comment on high reps with recovery times needed

• Avoid vibration
• Limit exposure to cold / intolerance
• Use of gloves
• Comments on use of tools (built-up handles)
• Awkward or sustained postures
• Graduated RTW schedules

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• The provision of the right health care at the
  right time.
• Return to best possible health
• The prevention of recurrences of worker
  impairment

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ADDITIONAL RESOURCES AVAILABLE IN THE MANAGEMENT
OF OCCUPATIONAL INJURIES / DISEASES - continued
Regional Evaluation Center (RECs) Regional
Evaluation Centers focus on musculoskeletal
injuries. They do help clarify the diagnosis,
prognosis and therapeutic options as necessary.
There are RECs in the following areas Ottawa,
Kingston, Peterborough, Oshawa, Toronto,
Hamilton, St. Catharines, Kitchener, London,
Windsor, Sudbury, Timmins, Kenora, Sault
Ste.Marie, and Thunder Bay. RECs are obligated
to schedule appointments within 10 days of
receiving the referrals, and must provide a
report within 10 days of the examination.
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ADDITIONAL RESOURCES AVAILABLE IN THE MANAGEMENT
OF OCCUPATIONAL INJURIES / DISEASES - continued
Specialty Clinics Injured workers may be
referred to Specialty Clinics through The
Workplace Safety and Insurance Board (WSIB).
These Specialty clinics provide expert
assessments in the following areas
Amputations and Burns, Upper Extremities,
Neurology (Head Injury or severe neck injury),
Prosthetics, Psychotraumatic Disorders, Chronic
Pain/Functional Restoration. These clinics were
initially centralized in the Toronto-Mississauga
hospitals but further decentralization is taking
place. Specialized opinions may also be obtained
from individual experts in specific disciplines.
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ADDITIONAL RESOURCES AVAILABLE IN THE MANAGEMENT
OF OCCUPATIONAL INJURIES / DISEASES

• The Occupational Health Clinics for Ontario
  Workers (Hamilton, Toronto, Windsor and Sudbury)
• Do specialized assessments,
• Review the literature as needed,
• Comment on possible work-relatedness of
  condition, etc.

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Contacts (1)
Health Professional Access Line 416-344-4526
or Toll Free 1-800-569-7919 Provider
Registration Section 200 Front St West, 4th
Floor Toronto ON M5V 3J1 Toll Free
1-800-387-0750 Fax [phone]
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Contacts (3)
Website www.wsib.on.ca For health care
professionals http//www.wsib.on.ca/wsib/wsibsite.
nfs/Public/HealthProfessionals To download
forms http//www.wsib.on.ca/wsib/wsibsite.nfs/publ
ic/Forms