Take Home Messages:
- Employers’ responses to workers on their return to work are important determinants of return-to-work outcomes.
- Employers’ responses to work disability may be negative or indifferent, with the result that many workers who initially return to work do not do so permanently. These workers experience feelings of rejection and of being undervalued in the workplace.
- Employer programs providing accommodations for injured workers have been shown to reduce time off work and to increase the likelihood of return to gainful employment. This study shows many injured workers do not receive accommodations, or receive only limited accommodations on their return to work.
- Some workers perceive their race or gender plays a role in their return to work experience.
- A welcoming and supportive approach makes a difference, and sensitivity to cultural and race issues is important.
Why the study matters:
A workplace injury results in significant changes in the life of the injured worker. Depending on the worker’s skills and limitations and the attitudes of their employer, the outcomes can include a change in jobs or employers, unemployment or withdrawal from the labour force.
What the study involved:
A study by Strunin and Boden, researchers at the Boston University School of Public Health, documented the experiences and perceptions of injured workers on their return to work and their reactions to their employer’s behaviour on their return.
Participants were selected from 845 Florida workers who had suffered a back injury at work during 1990 and who were paid either disability benefits or a compromise settlement.
Open-ended interviews were conducted in either English or Spanish approximately six years after the workplace injury occurred. Specific questions were asked about the participant’s perceptions of the behaviours of their supervisors, employers, co-workers, worker’s compensation, family members and friends, together with questions about the worker’s own behaviour, beliefs and attitudes.
Summary of research findings:
The researchers found that over 90% of participants in the study chose to return to their pre-injury job or place of work. However, those returning to work found their path of re-entry was also governed by decisions made by their employer.
The study participants described three distinct employer-determined paths of return to the workplace, which the researchers summarized as:
- Welcome back
- Business as usual
- You’re out
Return to the pre-injury workplace was the most common path experienced by the study participants (50%). In this scenario, the employer encouraged the worker to return to their pre-injury job and provided a work environment that was flexible to the injured worker. The employer’s behaviour indicated that the worker was a valued employee, and the worker felt that their employer was glad to have them back at work and wanted them to stay.
This perception is summed up by the following comment from a respondent:
“They wanted me to come back to work … they just treated me great.”
This positive attitude toward the employer persisted, even for those workers who were unable to continue working due to limitations imposed by their injuries.
Business as usual
The return-to-work experience of 26% of study participants was categorized as business as usual, characterized by a sense of benign neglect of the employer. In this path, the employer acknowledged the worker’s injury but neither helped or hindered their transition back to work. The employer made no adjustments for the injured employee, with the outcome being that the worker either continued in their pre-injury role, was fired or resigned. Workers experiencing this re-entry path believed that their employer was indifferent to whether they stayed or left and felt undervalued.
Another aspect of the business as usual path was that the injured worker was not always accommodated with a role that they could perform within the limitations imposed by their injuries. Thus, although the worker was given the opportunity to be re-employed, they felt that they were no longer a desired employee.
A common theme among workers in the business as usual path was that their welfare was irrelevant to the employer:
“He [the manager] couldn’t care less. All he wanted was his work done.”
Of the study participants, 24% reported that their employer either refused to re-hire them or that they were terminated by their employer soon after their return to the workplace. Workers in this category believed that they were terminated because they had suffered an injury and that their employer saw them as a liability and sought a reason to terminate their employment.
These workers experienced feelings of rejection and that they had no value in the workplace, irrespective of their term of service or experience. Many of these workers felt their employer’s behaviour was actively hostile and dismissive.
The following comment illustrates the feelings of rejection and hostility experienced by workers in this group:
“Once I had got injured they didn’t want me back….I didn’t want to lose 10 years of service, but they didn’t even give me a chance…”.
Light duty and special accommodations
Many study participants felt that the accommodations made at the workplace on their return to work were inadequate, including some workers who experienced the welcome back path.
Although 50% of all workers who returned to their pre-injury employer reported that they resumed work on light duties, some reported that they lost this position before they were ready to undertake heavier duties or that the light duty positions were no less strenuous than their pre-injury job or other jobs in the workplace. Furthermore, many workers reported that their employer made no attempt to accommodate their needs on their return to work.
Of the 159 injured workers who initially returned to work, 60 (38%) reported that they required special equipment to facilitate their re-entry to the workplace. However, less than half of these workers (48%) were provided with this special equipment by their employer.
Paths of re-entry: employment experiences of injured workers.
Strunin L, Boden LI.
American Journal of Industrial Medicine 2000; 38: 373-384.