Tertiary Prevention

Return to Work and Job Accommodation

Return to Work is a process to help workers who have suffered an injury or illness return to work as soon as safe and medically possible. The goal of Return to Work is an early return to safe and suitable work.

Return to Work can benefit employers by:

• Retaining experienced, skilled and knowledgeable workers.
• Reducing or minimizing financial costs, such as time loss, productivity, re-hiring and training costs.
• Fulfilling legislative requirements.
• Improving worker morale and relations.
• Demonstrating the value of workers.
• Providing consistency in the treatment of injured/ill workers.
• Reducing risk of similar injuries occurring by identifying and controlling hazards.
• Improving workplace health and safety culture.

Modified duties are a way to accommodate your worker's functional limitations. Job accommodations, whether temporary or permanent, help the injured/ill worker reintegrate into their job duties. This can also benefit the worker’s overall health by providing them with structure and routine, social interaction, physical and mental stimulation and a sense of accomplishment.

General accommodations can include:

• Working fewer hours
• Taking more frequent rest breaks
• Getting help from a co-worker on more difficult tasks
• Job/responsibility sharing
• Physical changes to the work environment
• Assistive devices
• Assignment to another job
• Special project work

 

Recall from Secondary Prevention, as the employer, your efforts to help workers with OSI/PTSD return to work should be founded on 7 principles:

1. The workplace is strongly committed to health and safety, as demonstrated by the behaviours of all workplace parties.
2. The employer offers modified work (i.e., job accommodation) to injured/ill workers so they can return early and safely to work activities suitable to their abilities.
3. Return to Work planners ensure that the plan supports the returning worker without disadvantaging co‐workers and supervisors.
4. Supervisors are trained in work disability prevention and included in Return to Work planning.
5. The employer makes early and considerate contact with injured/ill workers.
6. Someone has the responsibility to coordinate Return to Work.
7. Employers and healthcare providers communicate with each other about the workplace demands, as needed, and with the worker’s consent.

Legislative Requirements

Employers who facilitate early, safe and suitable Return to Work are meeting their legal responsibilities outlined in the following legislation governing workplaces:

Workplace Safety and Insurance Act (WSIA)

The WSIA, which is monitored and enforced by the Workplace Safety and Insurance Board (WSIB). Sections 40(1-2) and 41(5-6) accomplish the following:

1. Promotion of health and safety in workplaces.
2. Ensuring successful Return to Work of workers following work-related injuries or occupational illnesses wherever possible.
3. Providing compensation and other benefits to workers and survivors of deceased workers.
4. Facilitating re‐entry into the labour market for workers and spouses of deceased workers.

Occupational Health and Safety Act (OHSA)

Employers and supervisors are legally responsible for taking every precaution reasonable under the circumstances for the protection of workers. Workers are responsible for reporting risks and hazards.

Ontario Human Rights Code (OHRC)

The OHRC is the overarching legislation that requires employers to accommodate workers who seek accommodation due to disability up to the point of undue hardship. The employer has the onus to prove that an accommodation cannot be made based on undue hardship.

Accessibility for Ontarians with Disabilities Act (AODA)

The AODA aims to identify, remove and prevent barriers for people with disabilities in 5 areas: employment, customer service, information and communication, transportation, and design of public spaces.

Developing Your Return to Work Program

A Return to Work program is a proactive, formal plan that helps injured/ill workers remain at work or safely return to suitable work. Employers who have a process in place to make early and considerate contact with injured or ill workers are more successful in achieving safe and suitable Return to Work.

The goal of a Return to Work program is to return workers with OSI/PTSD to work that:

• Is consistent within their functional abilities,
• They have the skills to perform,
• Restores their pre-illness earnings, ideally returning to the pre-illness job to the extent possible, and
• Prevents reoccurrence of OSI/PTSD. 

Your Return to Work program for workers with OSI/PTSD should include the following 7 components.

1. Return to Work Policy

A Return to Work policy clearly states your organization’s commitment to workers’ health and safety. The policy must state what your organization wants to achieve with the program, the values and the philosophy of the program, how the program will operate, and who it will affect. It must be easily available to workers.

 

2. Return to Work Team

Your Return to Work program involves a team of people committed to getting the injured/ill worker back to suitable work as soon as is safe and medically possible. Your Return to Work team must include the worker and any of the following:

• Return to Work Coordinator or Committee
• Management
• Worker’s Healthcare Provider(s)
• Union (if applicable)
• WSIB

Assigning and communicating responsibilities helps ensure the Return to Work process is consistent and implemented according to plan.

 

3. Return to Work Procedures

In general, Return to Work procedures outline the steps the employer should take to assist a worker with return to work. Return to Work procedures begin as soon as a worker requests accommodation for their job due to OSI/PTSD symptoms, whether or not a formal diagnosis has been made.

Return to Work procedures should cover:

• What to do if a worker has a suspected or diagnosed OSI/PTSD.
• Documentation of individualized Return to Work plans.
• Monitoring Return to Work plans.
• Return to Work team roles and responsibilities.
• How to review and evaluate the Return to Work program.

See below for the 7 basic steps to follow for Return to Work procedures.

4. Return to Work Plan

A Return to Work plan is an individualized document developed collaboratively by the worker, the employer/supervisor, the treating psychiatrist or psychologist, and where appropriate, the Return to Work coordinator and/or union representative. The Return to Work plan outlines the worker’s specific needs.

A Return to Work plan includes:

• The Return to Work goal. The primary goal of Return to Work planning is to return the worker to work that is suitable.
• The actions and activities needed to achieve the Return to Work goal. The plan outlines the responsibilities of all Return to Work team members, including the worker themselves.
• Time frames for achieving these goals. Time frames help to measure the worker’s progress. The Return to Work plan should have a beginning and end.
• The worker’s healthcare needs. If the worker is seeing their psychiatrist/psychologist during work hours, the visits must be coordinated with the requirements of the proposed Return to Work plan.

 

See the WSIB’s Return to Work Plan Package document for additional guidance on the Return to Work Plan.

5. Return to Work Education and Training

As an employer, you should provide all workplace parties with the appropriate education and training to manage occupational stress illnesses impacting workers. Below are important topics on which to provide education and training.

a) Mental Health and PTSD

Employers must be aware that the work environment impacts both the physical and psychological well-being of workers. It is important that the employer, supervisors and workers are knowledgeable about mental health issues, prevention and management strategies, and where to access resources and tools.

Visit Workplace Strategies for Mental Health, Public Services Health & Safety Association and the Ontario Ministry of Labour, Training and Skills Development for ideas, tools and resources.

b) Anti-Stigma Awareness

Stigma is a negative stereotype. Workers with mental health conditions, such as PTSD, are at risk of being stigmatized by others in the workplace, including co-workers, supervisors and their employer. When a worker is being stigmatized, they are the subject of a negative stereotype. Negative stereotypes can lead to discrimination or unfair treatment due to a person’s identity, including a mental disorder.

As an employer, you can act to stop stigma and discrimination in the workplace. Use the Canadian Mental Health Association’s STOP criteria to recognize attitudes and actions that support stigma of PTSD and other mental health conditions in the workplace. Using STOP, consider your behaviours and the behaviours of others within the workplace:

• Stereotypes of workers with mental health conditions (i.e., assumption that workers with mental health conditions are all alike rather than individuals)?
• Trivializes or belittles workers with mental health conditions and/or the condition itself?
• Offends Workers with mental health conditions by insulting them?
• Patronizes Workers with mental health conditions by treating them as if they were not as good as other people?

Visit the Public Services Health & Safety Association for training on PTSD and anti-stigma awareness training.

c) Return to Work Program

All leadership and management should receive training in the organization’s Return to Work program components, including, but not limited to:

• OSI/PTSD signs and symptoms, and its health impacts.
• Return to Work and related policies and procedures.
• How to develop, implement and evaluate a collaborative Return to Work plan.
• Considerate and empathic communication.
• Relevant WSIB procedures.

6. Mental Health Resources and Support

Early psychological treatment is important for workers who have experienced a psychological injury or illness. To help your worker with PTSD recover and return to work, talk to them about the various resources and support that they can access.

a) Self-Assessments

If you or your worker suspect that they are suffering from work-related PTSD, your worker can complete a PTSD self-assessment. Visit the Canadian Institute for Public Safety Research and Treatment to access free online, anonymous assessment tools.

Note: Tools such as this are intended to educate workers about symptoms of PTSD and other mental health disorders, not to provide a clinical diagnosis. If a completed self-assessment indicates that a worker may be experiencing a mental condition, the worker should visit a qualified physician or registered and licensed mental health professional. To receive benefits from the WSIB, a worker’s PTSD must be diagnosed by a psychologist or a psychiatrist.

b) Employer Provided Benefits

An Employer Assistance Program (EAP) provided by the employer provides workers access to supports and resources across all aspects of their life and may include financial well-being, health and wellness, nutrition and balancing life, work and family commitments. An EAP can include access to mental health professionals with expertise in PTSD.

c) Community Support Programs

The following community support programs are provided by the Workplace Safety and Insurance Board (WSIB).

• Community Mental Health Program (CMHP) gives workers access to psychological assessment and treatment. Workers can access this program if they:
  • Have a registered WSIB claim or recurrence,
  • Have experienced a psychological reaction after a work-related physical injury, or
  • Have experienced a significant psychological response to a workplace incident or cumulative incidents, such as traumatic mental stress, chronic mental stress, or PTSD.
• Specialty Programs for assessment and treatment of complex work-related injuries and illness, such as mental health and occupational disease.  

d) Family and Peer Support

A worker’s family and friends can be engaged in the worker’s recovery and return to work. Support outside of the workplace may allow for quicker recovery and return to the worker’s pre-illness work. Involving friends and family may increase awareness of PTSD, reduce stigma, and increase community support in the general public. Examples of how friends and/or family can be engaged include:

• Hosting open houses, barbeques, family nights and other social events, which also provide information about OSI/PTSD.
• Providing family-based peer support that allows family members and peers to speak to others who have had similar experiences.
• Offering and funding for time-limited family counselling if required. Employers can make this available as part of their insurance benefits package (e.g., EAP).

7. Return to Work Program Evaluation

When evaluating your Return to Work program, the following metrics should be monitored and assessed:

• Duration of short and long-term disability related to OSI/PTSD.
• Workers’ use of your Employee Assistance Program (EAP).
• Workers’ use of your psychological support resources.
• Level of workers’ job satisfaction.
• Level of turnover and absenteeism.
• Level of stigma displayed by management and other workers related to injured/ill workers’ modified duties.
• Number of Worker complaints.

In addition to outlined Return to Work practices and modifications, as the employer, you should conduct voluntary assessments to address barriers to recovery and return to work for workers with OSI/PTSD.

Establishing Return to Work Procedures

See below for the 7 basic steps to follow when establishing your Return to Work procedures.

STEP 1: Seek Medical Attention

• If a Worker shows signs and symptoms of PTSD, suggest that they visit a psychiatrist or a psychologist for a OSI/PTSD assessment.
• Request that your Worker has their psychiatrist/psychologist complete the WSIB’s Functional Abilities Form for Planning Early and Safe Return to Work. To learn how to complete the form, see the WSIB’s Guide to Completing the Functional Abilities Form.
• Remind your Worker that the WSIB only provides benefits under the PTSD policy if the PTSD diagnosis is made by a psychiatrist or psychologist
• Remind your Worker to complete the WSIB’s Worker’s Report of Injury or Disease (Form 6)

STEP 2: Report PTSD Illness

Reporting an OSI/PTSD illness requires the following:

1. Getting medical attention - See Step 1
2. Investigating and documenting:
   • Investigate circumstances resulting in the worker’s OSI/PTSD.
   • Keep detailed records of signs and symptoms, incident(s) that may have triggered signs and symptoms and steps taken to correct the problem.
3. Reporting to the WSIB
   • Complete Employer’s Report of Injury or Disease (Form 7) within 3 days after learning of your worker’s PTSD diagnosi
     • Submit the form to WSIB.
     • Provide a copy to the worker.
     • Request Worker complete and submit Worker’s Report of Injury or Disease (Form 6) to WSIB.
4. Maintaining communication
   • Keep in touch with your worker and WSIB to plan for the worker’s return to work.

STEP 3: Communicate and Collaborate

• Contact your worker as soon as possible after they start medical care, whether a formal OSI/PTSD diagnosis has been made or not.
• Maintain contact with your worker throughout their recovery.
• Contact the WSIB regularly to update on the worker’s prognosis and suitable work options.
• If there is a job demands analysis or job description for your worker’s job and possible suitable work, provide this to the WSIB.

 

STEP 4: Identify Suitable Work and Create the Return to Work Plan

• Discuss with your Worker and the WSIB the worker’s functional abilities and recovery prognosis to identify suitable work.
• Document the identified suitable work in the worker’s Return to Work plan.
• Both the employer and the worker sign the Return to Work plan.
• Submit the Return to Work plan to the WSIB.

STEP 5: Implement and Monitor the Plan

• Check-in with your worker to monitor Return to Work plan.
• Provide regular updates to the WSIB.
• Communicate progress, problems or concerns to the WSIB.

STEP 6: Return to Work Completion

• Worker recovers and returns to their pre-illness job, or
• Worker reaches maximum recovery and requires permanent accommodation.

STEP 7: Evaluate the Worker’s Return to Work Process

• To improve processes for future Return to Work situations, determine what went well and what could be improved.