The report, New Directions: Report of the WCB Review 2019, identified 3 essential elements for a compensation system that treats injured workers with dignity and respect, and supports their recovery:
- Respectful communication
- Consideration of Individual Circumstances
- Patient-Centred Medical Care
The last two elements are well understood: injured workers deserve to be treated as individuals (not widgets) and have their recovery paths guided by trusted health professionals (not file reviews). But the practical role of “respectful communication” is perhaps, less well understood.
In the 200 presentations to the Review by workers, family members and advocates, the crucial role of “communication” was identified again and again as a key factor. In the New Directions report, I recited some of the negative examples given to me, where WCB staff dismissed a worker’s phone call with indifference or worse, with contempt or where a case manager continued to demean, berate, belittle or swear at them. A number of workers reported being called “losers” (see pages 66-69). The impact of these remarks went beyond distress and were identified by workers as key factors in their disability journey – often remembered in vivid detail, years later.
One eloquent presentation came from Kristen Thompson, the wife of an injured worker – Caley Thompson.1 In her presentation, Kristen highlighted the impact of two different types of communication styles on her husband’s recovery. At first:
It was the caseworker’s understanding and appreciation for the circumstances that gave Caley the confidence to move forward and continue on his path to returning to work as a millwright. For that I will be forever grateful…
But in the second claim…
The case worker that had been assigned to our file was the exact opposite from our previous case worker. She didn’t believe my husband. Because of that she wouldn’t listen to anything that he had to say and would constantly talk over him. She had a knack for leaving all the important information she needed to pass on as a message 4:30 on a Friday afternoon, so we were not able to return her call until Monday and got to stew over any bad news all weekend until we were able to get an explanation…
It has been the actions of the WCB and its advocates that have pushed my husband to the point that he feels the only way anyone will believe his struggles is to end his life. (New Directions, pages 67-68)
We know that any act of communication conveys much more than information. It conveys the speaker’s attitude and relationship to the listener. In fact, “communication practices” as a whole effectively convey messages about whether the speaker regards the listener as someone worthy of respect and whether the speaker is prepared to treat them with the dignity that they deserve. The “communication practices” include the choice of words and tone of speech but also other practices such as prompt responses, good listening, considerate and respectful timing of phone calls and willing accommodation of any communication difficulties (such as hearing or speech or cognitive deficits). The absence of these considerations conveys the opposite view – that the speaker is indifferent or dismissive of the listener’s needs and dignity.
The Board’s communication practices greatly affect injured workers because these practices contribute to the picture of how an injured worker is treated after a work injury, a picture which often includes stigma and discrimination.
“Stigma” generally refers to a mark or identifying characteristic which society regards as deserving disgrace, strong lack of respect or a negative status. At the time that I wrote New Directions, I did not have the benefit of knowing that the stigmatizing of injured workers had been extensively studied elsewhere. This blog seeks to fill that gap.
From 2005-2011, a community-based research project called the Research Action Alliance on the Consequences of Work Injury (RAACWI) received significant funding. The research projects were based on the work of an Injured Workers History Project team, which had produced a brochure and video “Their Only Power Was Moral: A History of Injured Workers in Ontario”. This material and the subsequent RAACWI research projects & reports are available at Injured workers online.
The RAACWI research found that cutbacks in the compensation structure of benefits and entitlement greatly affected the compensation culture and attitudes towards injured workers. They found that as changes in the laws and regulations made it increasingly difficult for injured workers to have their claims accepted, injured workers were increasingly stigmatized and marginalized.
The RAACWI has shared this research through publications, reports, conferences and educational forums. They also engaged the Ontario compensation board – WSIB – in an “anti-stigma” initiative, resulting in a WSIB publication, “The Facts About Injured Worker Stigma“.
The anti-stigma brochure begins with the worker’s experience of injury:
Following a workplace injury, a number of changes take place
- Loss of gainful employment
- Challenges to the worker’s own internal sense of well-being
- A difference in the way friends and family regard them
These changes – along with the necessity of dealing with health professionals and claims adjudicators – serve to reinforce the sense of having a new and less socially-valued identity to get used to: the identity of being an injured worker.
This sense of having less worth, as a result of an injury, can be either ameliorated or amplified by how the injured worker is treated by others. Too often, injured workers are treated in ways which exacerbate their disability. As the brochure notes:
Many individuals report being treated differently- stigmatized – after they’ve been injured on the job. They are made to feel ashamed of their physical limitations and reduced income.
This sense of shame isolates people from their co-workers, friends and family. It can also lead to clinical depression, other mental health problems and even slow the injured worker’s physical recovery. Many myths exist about injured workers that contribute to injured worker stigma. These myths impact the way they are treated in workplaces, the health care system and in their communities.
The brochure then explores and explodes a number of stigmatizing myths. I am familiar with all of these myths which are alive and well in the B.C. compensation system – that workers are lazy, they have a sense of entitlement and they take away from the WCB system (vs. employers who contribute to it) or that fraud is widespread. The brochure rejects all of these myths as untrue and as stigmatizing injured workers.
There is another matter.
In B.C., injured workers are often treated as if they were responsible for their injury due to some alleged carelessness, PPE problem, etc. This is another stigmatizing attitude that must be rejected. Matters which are addressed by the OH & S regulations have absolutely no place in a no-fault compensation system, which is carefully structured to blind itself to fault issues – for employer and worker alike. “Victim blaming” is not only inappropriate; it serves to deepen the stigma that is visited on workers, to one of “you either caused this or are lying about it”.
The section on Ending Injured Worker Stigma sets out the practical steps which WSIB took, and continues to take, to fight and correct these corrosive attitudes. The whole brochure is worth reading and is only partly quoted here:
The WSIB has partnered with…RAACWI to help eliminate prejudice and discrimination against injured and ill workers. Initiatives to address this problem include:
- Raising awareness about stigma and its effects with all WSIB employees – especially frontline Operations staff – who deal directly with injured workers.
- Examining our systems and procedures to address those that reinforce stigma….
We’re also bringing the issue of injured work stigma to the forefront of our outreach initiatives and making sure that our contracted service providers understand and share our responsibility to treat injured and ill workers with courtesy, dignity and respect.
Our service commitment extends to providing fair and equal access to the programs and benefits workers are entitled to, at times and in ways that are convenient to them and that support their diverse and unique needs...
We believe that it is important to make a difference – not judgments.
In the end, injured workers need a compensation system that recognizes and compensates their real losses. But they also deserve to be treated with dignity and respect throughout the compensation process. I suggest that our B.C. Board review the RAACWI research on the stigmatization of injured workers and adopt the “anti-stigma” initiative, pioneered in Ontario. And the brochure’s ending should be the motto on every WCB desk:
Getting injured on the job is nothing to be ashamed of; stigmatizing injured workers is.
- Both of them gave their permission to have Kristen’s full submission, complete with pictures, to be included in the New Directions report (Appendix 4). ↩︎
Originally published on the Worker Education website by former WELLS Director Janet Patterson.