On a snowy, slippery day in December 2013, Hamilton resident Jeannie Howe smashed her head and back in a workplace fall.

Eight weeks later, she was back on the job. She was at least happy to get out of the house, but she remained groggy and suffered from “constant headaches.”

According to Ontario’s Workplace Safety and Insurance Board, a swift return to work is the best way for injured workers to recover — and is part of the board’s “evidence-based approach” to helping accident victims.

Experts and injured worker advocates say the board’s return-to-work program is not actually evidence-based at all. Instead, they say, in practice the policy cloaks cost-cutting measures in misunderstood and poorly applied research.

The result, critics argue, is that vulnerable workers are often forced back to work too soon, sometimes against their doctor’s orders, into “modified” jobs that can be demeaning and potentially harmful.

“The way the policies are drawn up, there isn’t a lot of nuance between making sure someone doesn’t lie down for six months with a bad back, which is good practice, and forcing people to go back to a completely meaningless task, which is bad practice,” said University of Ottawa professor Katherine Lippel.

“Humiliating and demeaning work is not therapeutic.”

According to board statistics, some 92 per cent of claimants now safely and quickly return to meaningful employment after an accident. In a statement to the Star, the board said its early return-to-work program was adopted in 2010 “following a decade of poor return-to-work and recovery outcomes for workers.”

“Our return-to-work program is an evidence-based approach aimed at achieving the best possible outcome for injured workers,” it said.

But having conducted several studies of the early return-to-work policy in Ontario over the past decade, University of Waterloo professor Ellen MacEachen says she is skeptical about how that evidence has been implemented.

“The best I could come up with is there’s a lot of back pain research that talks about rest being bad and activity being important. All of these ideas are broadened to return-to-work (policies). But not everyone has a back injury,” she told the Star.

“It’s all done in the name of preventing chronic disability, and part of that is quite legitimate,” said Lippel, who teaches law and is a former adjunct scientist at the Toronto-based Institute for Work and Health. “But saying that what works for bad backs works for post-traumatic stress disorder, for instance, is clearly not the case.”

“It’s the unfunded liability that is driving all of this,” she added, referring to the board’s future debts — currently sitting at about $6 billion.

In its statement to the Star, the board said its early return-to-work policies are “not a cost saving measure.” In a 2014 speech at the C.D. Howe Institute, former WSIB president David Marshall said new research proved that early return-to-work was in the best interests of workers. It would also, he noted, save money at the board.

“We realized with clarity and urgency that if we were going to deliver value for our stakeholders and reduce costs, we would have to help workers recover and get back to work as early and safely as possible,” he said.

“We have fundamentally cut the length of time that workers are off work and therefore needing benefits.”

In an ongoing investigation into WSIB practices, the Star has highlighted criticism that reform at the board, aimed at reducing its significant unfunded liability, has sometimes come at the expense of proper care for injured workers. While the board says its early return-to-work program is about getting accident victims “back to health and safe, suitable work,” critics say, in practice, that is not always happening.

In 2012, for example, an independent review of WSIB practices conducted by former York University president Harry Arthurs said encouraging workers to return to their jobs was laudable, but warned that the current system created “pressure for workers to return to work prematurely or to ‘non-jobs’ where they perform meaningless functions until it is advantageous for the employer to dismiss them.” That is because employers are penalized for every day their workers lose time on the job — starting immediately after their accident.

Workers can be kicked off benefits if they refuse accommodated duties — even if their doctors say they should not be working or that modified work makes their symptoms worse, said Aidan MacDonald, a lawyer for the Toronto-based legal clinic Injured Worker Consultants.

MacDonald says he acted for one client who was forced back to work against her doctor’s orders; her modified work plan involved stapling documents together all day — even though the office photocopier did the same thing. Another client’s accommodated duties consisted of sorting nuts and bolts into buckets. Yet another client was called up by his boss while still in hospital to try to get him back on the job.

“There is no strong mechanism to make sure that we’re not putting both employer and workers in ridiculous situations,” said Lippel. “And the ridiculous situations are harmful to the workers’ health, and they are harmful to the relationship between the employer and the worker.”

“You get mocked and jeered by your co-workers. You’re getting paid and they have to actually work for their pay and you’re sitting in the cafeteria. It can be very humiliating for workers,” MacEachen added.

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That, says 38-year-old Jeannie Howe, was her experience.

After falling in 2013 while working for a car rental company, Howe says, she fractured her rib and was later diagnosed with a concussion and whiplash causing crippling headaches. She went back to work after the eight weeks’ recovery allowed by the board and was initially reassigned to dust, clean countertops and move cars around the parking lot. But she says her colleagues harassed her and accused her of “doing nothing” — even filming and taking photos of her on the job.

“Going back to work and doing something as opposed to being at home and thinking about the pain is a great idea,” she said. “But (the board) has no idea what co-workers do (to you).”

Her concussion, she says, left her with cognitive difficulties and she says her driver’s licence was eventually suspended. At that point, she says, the WSIB said her employer no longer had a duty to accommodate her — and she was cut off benefits.

“I pretty much broke down. I went to see a therapist and I broke down. I couldn’t handle the amount of stress,” she said.

In a statement, the WSIB said employers had a duty to accommodate and reintegrate injured workers, but said the link between Howe’s experience and the board’s return-to-work policies was “unclear.”

But MacDonald says being forced back to work too early or into meaningless jobs can be counter-productive for workers and their bosses alike.

“When people aren’t able to keep up with their jobs because they’re in pain, their production suffers. They come under increased pressure from employers and co-workers, which can cause significant feelings of depression and anxiety.”

The Star asked the board how it monitored the success of its return-to-work policy. In response, the WSIB said it looked at the number of workers in employment with no wage loss one year after their accident. The WSIB said it didn’t track what happens to injured workers beyond a year in the job, although it held more than 22,000 worksite visits in 2015 to “to assist injured workers and employers facilitate return to work.”

“The WSIB does not systematically follow up with injured workers following their return to work,” the board said in a statement.

A 2015 study conducted by professors at McMaster and Trent Universities looking at injured workers with permanent impairments in Ontario found that 46 per cent were living on the poverty line five years after their accident.

“What you have to evaluate and what I haven’t seen many people evaluate is whether the nature of the alternative work that’s being offered is doing more harm than good,” said Lippel.

In the meantime, the flaws in the program are “just not right,” she said.

“It’s not morally right — and it’s not good science.”