A case study
WorkSafeBC accepts a claim for back strain from a 34-year-old sheet metal worker. The worker’s physician sees him regularly for 8 weeks, and since the worker’s symptoms are consistent with mechanical low back pain, continues to report that the patient is un­able to work. 

Meanwhile, the employer offers light duties, which the worker declines; but the physician is unaware of the offer. A WorkSafeBC officer adjudicates that the light duties are within the worker’s abilities, and thus, WorkSafeBC reduces the worker’s wage-loss benefits from the date the employer offered light duties. 

The patient complains to the physician that he was “cut off.” What happened?

WorkSafeBC’s policy
According to WorkSafeBC’s policy, to ensure that the early return to work is appropriate, all selective/light employment arrangements must meet the following conditions:

• While the injury may temporarily disable the worker from performing normal work, the worker must be capable of un­dertaking some form of suitable employment.

• The work must be safe; that is, it will neither harm the worker, nor slow his or her recovery. The work must be within the worker’s medical re­strictions, physical limitations, and abilities. If there is a disagreement regarding the safety of the selective/light offer and WorkSafeBC is required to intervene, WorkSafeBC is responsible for determining the safety of the work, after considering the medical evidence and other relevant information.

• The work must be productive. Token or demeaning tasks are considered detrimental to the worker’s rehabilitation.

• Within reasonable limits, the worker must agree to the arrangements.

Avoiding a “disability mindset”
According to the second edition of Occupational Medicine Practice Guide­lines by the American College of Oc­cupational and Environmental Medicine, the consequences of disability are profound, yet “many workers and their families are unaware of the harm that may result from unnecessary absence from work” (page 75).

The guidelines point out that, “It is important to stay alert to the issue of elapsed time away from work. Over 4 weeks should be considered in the danger zone. By 1 month, many pa­tients begin to develop a disability mindset” (page 79). Additionally, setting expectations has been shown to play a vital and positive role in influencing a worker’s return to work.

Case study: A better approach
Another 34-year-old sheet metal worker slips and falls at work. The injured worker sees her physician on day 3 post-injury.

• The physician does a thorough history and physical examination, re­viewing red flags, signs, and symptoms. Apart from pain, tenderness, and reduced range of motion, the exam is normal and the diagnosis is mechanical low back pain.

• The physician reassures the patient that the outlook for patients with similar injuries is very good; most return to work in a few days and recover completely in 1 month; pain­ful flares will occur, but pain, in and of itself, is not an indication that the activity is harmful. In fact, excessive rest can be harmful.

• The physician acknowledges that activity is beneficial and plays a vital role in rehabilitation, recommending a short period of relative rest/activity modification, such as 2 days of light activity, and referring the patient to a physiotherapist.

• The physician acknowledges that returning to heavy work right away may not be possible, but recommends that the worker return to work within a week to perform modified du­ties, including sedentary level lifting, ideally at waist level to start—pa­tient should have the ability to change positions; for example, be­tween sitting and standing, as required.

• The patient continues with modified duties and is contacted by a WorkSafeBC nurse advisor in 3 to 4 weeks. She continues to have pain, but is improving; modified duties are re­viewed and a plan implemented to progress work hours and duties.

• Patient is seen regularly by her phy­sician. The history and physical ex­amination remain unchanged; the physician continues to provide assurance regarding recovery and re­mains supportive of modified duties and progression of duties.

• The physician sees the patient for a final follow-up. The physician notes ongoing pain complaints, with im­provement, and recommends that the worker return to full hours and full duties at work.
—S. Michele Dalgarno, MD, CCFP
Senior Medical Advisor

This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.