Previous Research

Since the late 1970’s, a number of studies have examined the post-injury employment histories of injured workers with disabilities in the U.S. and Canada. Most of these studies have been primarily concerned with identifying the characteristics of injured workers which correlate with different post-injury employment outcomes.

Gender

Most U.S. studies have found that men tend to return to work sooner than women (Johnson and Ondrich, 1990: 585). A 1989-90 Ontario survey of long-term post-injury employment patterns found that women were just as likely as men to return to work, but those women who did return to work were much more likely than men to experience subsequent periods of injury-related absences from work (Butler, Johnson, and Baldwin, 1995: 466: Johnson, Baldwin, and Butler, 1998: 26). A different study of Ontario workers with musculoskeletal injuries found that men were more likely to return to work, but those women who managed to return to work were more likely than men to remain employed (Crook and Moldofsky, 1994).

Marital Status

When marital status is examined along with gender, married men are more likely to return to work than both females and unmarried men (Allingham and Hyatt, 1995: 175). Unmarried women are more likely to return to work—and sooner—than married women (Johnson and Ondrich, 1990). Johnson and Ondrich suggest that married women are less likely to return to work because they “compensate for the limiting effects of their disabilities by substituting household work for working for wages” (1990: 585).

Age

Most studies have found that older workers are less likely to return to work than younger workers (Baldwin and Johnson, 1998; Johnson, Baldwin, and Butler, 1998; Crook, Moldofsky, and Shannon, 1998).

Type and Severity of Disability

Johnson and Ondrich (1990) found that type of disability is a more important influence on return to work than severity. They found that persons with amputations or bruises and contusions were more likely to return to work sooner than persons with sprains, dislocations, or fractures (1990: 584). ^[20] Butler, Johnson, and Baldwin (1995) argue that other factors can interact with a workers’ type of impairment to exacerbate the work disability he or she experiences.

“Many workers with less than high school education work in physically demanding jobs. As the workers age, their physical capacity declines and their risk of developing a back problem increases. For a low-skilled worker, an episode of back pain is typically disabling because the usual work of such an employee is physically demanding and the worker’s ability to perform other jobs is limited by his or her lack of skills. Unless low-skilled workers are protected by seniority rules, such as those mandated by labor unions, those who can no longer perform physically demanding tasks because of a back condition have few opportunities to move to less demanding occupations. If their employers are unwilling or unable to reduce the physical demands of their usual jobs, these workers are likely to be totally work-disabled even though they are physically capable of doing many other jobs. More skilled workers with the same back conditions are likely to be employed.” (Butler, Johnson, and Baldwin, 1995: 462-463)

A recent survey of 113 injured workers across Canada found that most respondents felt that persons with soft tissue injuries have greater difficulties than persons with amputations and other clearly visible disabilities (Canadian Injured Workers Alliance, 1995a: 35). In a study of injured workers in Wisconsin, Galizzi, Boden, and Liu report that injured workers with back injuries face particular challenges because their subjective pain and limitations often do not correlate with objective symptoms (1998: 5).

Pre-Injury Wage

Two studies based on data collected in the 1970’s in Florida, New York, Wisconsin, and Illinois found that workers who earned higher wages at the time of their injuries tended to return to work sooner than workers with lower pre-injury wages (Butler and Worrall, 1985; Johnson and Ondrich, 1990). Similar results were found in a study of injured workers in Ontario (Allingham and Hyatt, 1995).

Post-Injury Earning Potential

Baldwin and Johnson found that injured workers with higher post-injury earning potential were more likely to return to work (1998: 51).

Education

Most studies have found that better educated workers are more likely to return to work than less educated workers (Johnson and Ondrich, 1990: 584-585; Allingham and Hyatt, 1995: 175). For example, Butler, Johnson, and Baldwin (1995: 462) found that 80 per cent of a sample of Ontario injured workers who did not return to work had less than a high school education. The authors suggest these explanations:

“First, a physical impairment is less likely to limit the job performance of better-educated workers because their jobs are not usually physically demanding. Second, better-educated workers have more control over the manner in which they perform their jobs, allowing them to compensate for physical limitations by changing the manner in which they do their usual work. And third, firms’ greater investments in training better-educated workers than less-educated workers, and the relatively high transaction costs of replacing better-educated workers, increase employers’ incentives to provide workplace accommodations for those workers.” (1995: 462)

Most of the studies conducted during the 1970’s, 1980’s, and early 1990’s were primarily concerned with injured workers’ first returns to work. For example, a study conducted for the Alberta Workers’ Compensation Board examined the number of claimants who received vocational rehabilitation services from workers’ compensation boards in eight Canadian provinces in the 1980’s, as well as the number who subsequently returned to work. It found that 7 per cent of claimants with time-loss injuries were referred for vocational rehabilitation services, and 47 per cent of them subsequently returned to work (Association of Workers’ Compensation Boards of Canada, 1998: 9-10, citing Robertshaw, 1991).

Most of these studies assumed that a first return to work after a disabling injury is an accurate predictor of long-term employment success (i.e. a return to work signals a successful end to the worker’s injury-related absence from work). ^[21] Several of the authors of these early studies noted, however, that this was not always true. For example, Ginnold (1979) found that 25 per cent of Wisconsin workers injured in 1968 who returned to their jobs were not employed eight years later (1976). Most of these workers identified their injuries as the reason they were not working. Similarly, Johnson, Cullinan, and Curington (1979) found that approximately 20 per cent of a sample of U.S. workers who sustained permanent partial impairments in 1970 and returned to work were not employed in 1975, most for at least one year.

The Canadian Injured Workers Alliance (CIWA) conducted a study of the vocational rehabilitation and re-employment experiences of 113 injured workers across Canada in 1995 (Canadian Injured Workers Alliance, 1995a and 1995b). It is the only previous study of the post-injury employment of injured workers with disabilities in Canada we are aware of that is based on the first-hand descriptions, beliefs, and opinions of injured workers.

It emphasizes that “returning to work and keeping a job permanently are two entirely different matters” (Canadian Injured Workers Alliance, 1995a: 49; italics in original). 67 of 113 respondents had returned to work at least once since their injuries, most with their pre-injury employers (1995a: 64). However, more than half of those who initially returned to work—38 of 67—were not working at the time of the survey (1995a: 49).

CIWA reports that most of the survey respondents who managed to return to work at least once:

“…gave little credit to the Compensation Boards, Workers’ Advocates, employers, unions or other agencies and mechanisms which exist to assist in the return to work. Rather the two reasons cited most often by respondents for their return to work gave credit to their own initiative and personal support from family, friends and co-workers.” (Canadian Injured Workers Alliance, 1995a: 49)

Survey of Ontario Workers with Permanent Impairments (1989-90)

The most comprehensive and methodologically rigourous studies of the long-term post-injury employment histories of injured workers with disabilities in North America are based on data from a survey of Ontario injured workers in 1989-90. The Survey of Ontario Workers with Permanent Impairments was conducted by the Workers Compensation Board of Ontario, and collected data from 10,500 injured workers in that province who had permanent partial disability assessments between June 1989 to June 1990. The survey ork left or lost their jobs for reasons related to their injuries, and had not worked since (Pattern 2). 21 per cent experienced multiple spells of work and unemployment, but were working at the time of the survey (Pattern 3). 11 per cent experienced multiple episodes of work and unemployment, and were not working at the time of the survey (Pattern 4).

When Baldwin and Johnson examined a subset of workers with back injuries, the error of using first return to work as a measure of success was even more apparent: nearly half of the injured workers with permanently-disabling back injuries who initially returned to work were not employed—for reasons related to their injuries—at the time of the survey (1998: 49).