Journal of Occupational Rehabilitation

, Volume 20, Issue 3, pp 349–366 | Cite as

The “Toxic Dose” of System Problems: Why Some Injured Workers Don’t Return to Work as Expected

  • Ellen MacEachen
  • Agnieszka Kosny
  • Sue Ferrier
  • Lori Chambers


Introduction Most workers who incur an injury on the job follow a relatively straightforward path through a workers’ compensation claim, recovery and return to work. However, a minority of compensation claims is prolonged and can be disproportionately costly. We conducted this qualitative study in order to gain an understanding of systemic, process-related problems affecting injured workers who had failed to return to work as expected. Method A total of 69 in-depth interviews were conducted with injured workers with complex and extended workers’ compensation claims and with return-to-work (RTW) providers such as health care providers, insurers, legal advisors, and workplaces. The study was based in Ontario, Canada. A modified grounded theory analysis led to the identification of common mechanisms in RTW problems. Results We identify problems with return to work and extended workers’ compensation claims in dysfunctions in organizational dynamics across RTW systems including the workplace, healthcare, vocational rehabilitation and workers’ compensation. These system problems are difficult to identify because they appear as relatively mundane and bureaucratic. These appeared to have damaging effects on workers in the form of a ‘toxic dose’ affecting the worker beyond the initial injury. Conclusions Worker’s problems with extended claims were linked to RTW policies that did not easily accommodate conflict or power imbalances among RTW parties and by social relations and processes that impeded communication about RTW situations and problems. Avenues for intervention are located in a shift to a critical lens to RTW process that addresses differences of knowledge, resources, and interests among different parties.


Return to work Qualitative Injured workers Workers’ compensation System challenges 



Funding for this study was received from the Ontario Workplace Safety and Insurance Board Research Advisory Counsel. This funding does not imply endorsement of the research findings. We thank the injured worker representatives, occupational health physicians and workers’ compensation policy makers who comprised the study Advisory Committee and who provided thoughtful advice and reflections over the course of the study. Finally, we thank Diana Pugliese for her help with arranging and editing this paper.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ellen MacEachen
    • 1
    • 2
  • Agnieszka Kosny
    • 1
    • 2
  • Sue Ferrier
    • 1
  • Lori Chambers
    • 1
    • 2
    • 3
  1. 1.Institute for Work & HealthSuite 800, TorontoCanada
  2. 2.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.The Ontario HIV NetworkTorontoCanada

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