THE UNIVERSITY OF WESTERN
ONTARIO
Department of
Epidemiology and
Biostatistics
2003
Francine Lortie-Monette, MD, MSc, CSPQ, MBA
Workers’
Compensation in
Ontario:
Workplace Safety and
Insurance Board
(WSIB)
Roles of Physicians:
Prevention
Diagnosis
Treatment/medical management
Facilitating return to work
Reporting
WSIB/MOLTC
Agreement
Business continues to be conducted
under an agreement that was
reached in October 1990 between
the WSIB and MOH
FILING A CLAIM WITH WSIB Once a claim has been filed, a practitioner who
has examined or treated the worker has a duty 1
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.
1
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.
Difficult!
incomplete medical information
poor communication
F.D. frequently misunderstands
WSIB/employer/employee role
Body Part
Evidence for Causal Relationship
between physical work factors and
musculoskeletal disorders 1
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
1 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.
WSIB Statistics-2001(1)
Accidents registered = 375,000
Allowed
= 74%
Abandoned
=
Denied
=
Pending
=
Amalgamated =
16%
3%
6%
1%
Need for specific, objective information:
objective medical findings
treatment plans
notification re: precautions (ie?)
RANGE OF MOTION TESTING
Active and Passive
Multiple Directions
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 patient’s job demands as one of the treatment goals.
Prolonged absence from one’s normal roles, including absence
from the workplace, may be detrimental to a person’s mental,
physical and social well-being.
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.
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.
In the view of the CMA &
the OMA:
It is not the treating physician's
responsibility or role to determine whether
the patient’s condition meets the insurer’s
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
“Injury/Illness & Return
To Work/Function:
A Practical Guide for Physicians”
Prepared by the Physician Education
Project in Workplace Health in conjunction
with the OMA and the WSIB
What is the Functional Abilities
Form (FAF)?
Highlights limitations
Optional tool completed at the request of
either of the workplace parties
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.
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
WSIB information hotline: 1-800-465-5606
in a workplace-specific functional abilities form.
The Functional Abilities Form
Employer
Requests from the worker a copy of the Form 2647A
Worker
Having signed consent, brings a copy of it along
and a copy of the worker’s 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.
with Form 2647A to the attending health professional.
Asks the professional to complete the form.
Completes the form, gives the employer the canary
Health
Professional yellow copy, gives the worker the pink copy and sends
the white copy to the WSIB.
The white copy also serves as the professional’s
invoice for payments.
The FAE form may be faxed.
Physical Demands
Material Handling:
Lifting
Carrying
Pushing
Pulling
Non-Material
Handling:
Stand/sit/walk
Stoop/kneel/crouch
Reaching
Fingering
Handling
Grasp / Pinch
Tool Use
Physical Demand Characteristics of Work
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
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)
>1 rep every 5 min
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)
>500 reps over 8hr
Consistency of Effort Testing
A combination of tests / no “one indicator”
Kinesio-physical Approach
Normal expectations ie Push > pull, shoulder height values
< 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 (>50% CV > 15%)
*Jamar Grip (Expected Bell Curve* / CV*)
Controversial if solely used
*Caution-Ref. Shechtman, Journal Hand Therapy, July 2001
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.
OCCUPATIONAL
Health Stressors:
Work monotony
low job control
mental stress
perception about work
lack of flexibility
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
The provision of the right health care at
the right time.
Return to best possible health
The prevention of recurrences & of worker
impairment
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.
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.
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.
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 416-344-2955
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/public/Forms