eriences of Decision Makers in the Workers' Compensation System:
Impact of Gender on Return to Work Decisions

Maria Stancati Ens
B.A., Simon Fraser University, 1990

Thesis Submitted in Partial Fulfillment of
The Requirements for the Degree of
Masters of Arts
in
Disability Management

The University of Northern British Columbia
May 2009
© Maria Stancati Ens, 2009

1*1

Library and
Archives Canada

Bibliotheque et
Archives Canada

Published Heritage
Branch

Direction du
Patrimoine de I'edition

395 Wellington Street
Ottawa ON K1A0N4
Canada

395, rue Wellington
Ottawa ON K1A0N4
Canada

Your file Votre reference
ISBN: 978-0-494-48731-0
Our file Notre reference
ISBN: 978-0-494-48731-0

NOTICE:
The author has granted a nonexclusive license allowing Library
and Archives Canada to reproduce,
publish, archive, preserve, conserve,
communicate to the public by
telecommunication or on the Internet,
loan, distribute and sell theses
worldwide, for commercial or noncommercial purposes, in microform,
paper, electronic and/or any other
formats.

AVIS:
L'auteur a accorde une licence non exclusive
permettant a la Bibliotheque et Archives
Canada de reproduire, publier, archiver,
sauvegarder, conserver, transmettre au public
par telecommunication ou par Plntemet, prefer,
distribuer et vendre des theses partout dans
le monde, a des fins commerciales ou autres,
sur support microforme, papier, electronique
et/ou autres formats.

The author retains copyright
ownership and moral rights in
this thesis. Neither the thesis
nor substantial extracts from it
may be printed or otherwise
reproduced without the author's
permission.

L'auteur conserve la propriete du droit d'auteur
et des droits moraux qui protege cette these.
Ni la these ni des extraits substantiels de
celle-ci ne doivent etre imprimes ou autrement
reproduits sans son autorisation.

In compliance with the Canadian
Privacy Act some supporting
forms may have been removed
from this thesis.

Conformement a la loi canadienne
sur la protection de la vie privee,
quelques formulaires secondaires
ont ete enleves de cette these.

While these forms may be included
in the document page count,
their removal does not represent
any loss of content from the
thesis.

Bien que ces formulaires
aient inclus dans la pagination,
il n'y aura aucun contenu manquant.

Canada

Acknowledgements
I attribute the completion of my graduate studies and this thesis to all the people who
have offered their support along the way. I would like to extend a special thank you to my
supervisor, Dr. Henry Harder, for the giving me the opportunity to pursue my academic
dream. I would like to also thank my committee members, Dr. Shannon Wagner and Dr. Lela
Zimmer, and external examiner Dr. Jacqueline Holler. As well, many thanks to my colleague
and classmate, Lydia Arnold-Smith, whose friendship and support I will cherish for a lifetime.
Thank you to my husband, John, and my children, Lucas and Mathew, for their unrelenting
love and devotion. I would like to thank my parents for supporting me, believing in me, and
encouraging me to embrace the gift of lifelong learning.

Abstract

A literature review on gender and compensable return to work revealed a lack of
information specific to whether the gender of an injured worker has an impact on decision
makers within a compensation system. This phenomenological study was undertaken to
examine the phenomenon of gender and the lived experiences of the decision makers in the
compensation system. The purpose of the study was to gain an understanding of how the
gender of an injured worker influences the decision makers' return to work decisions.
Findings from the data analysis revealed that the phenomenon of gender does have an
influence on the decision makers in the compensation system and their return to work
decisions. The five major themes emerging from the data include: understanding the decision
maker, role of the injured worker, communication, case management, and law and policy.
There are several sub-themes subsumed within each of the major themes.

11

TABLE OF CONTENTS
Abstract

11

Table of Contents

in

Chapter One

Introduction
Significance of the Study
Purpose of the Study
Research Question

1
4
5
5

Chapter Two

Literature Review
Introduction
Health
Psychological/Social
Vocational
Workers' Compensation System
Decision Making
Disability Management
Conclusion

7
7
7
8
12
15
17
20
25

Chapter Three

Research Methodology
Orientation of the Study
Research Site
Study Participants
Data Collection Process
Ethical Considerations
Data Analysis
Report Writing

27
27
29
30
31
32
34
37

Chapter Four

Findings and Discussion
Introduction
Findings
Role in Return to Work
Training
Central Theme
Major Themes and Sub-Themes
Understanding the Decision Maker
Decision Making Approach
Stereotyping the Worker
Framing the Return to Work Decision
Gender of the Decision Maker
Self Awareness
The Injured Worker
Trust
Control of Return to Work

39
39
40
40
41
42
43
43
43
45
46
48
51
53
53
54

iii

Communication
Meeting with the Injured Worker
Delivering the Return to Work Decision
Case Management in WCB
Team
Introduction of the Psychological-Social Issues
Severity of Injury
Law and Policy
Neutrality
Value Conflict

57
57
61
63
63
64
66
68
68
71

Chapter Five

Summary, Conclusion, and Recommendations
Summary
Conclusion
Recommendations and Implication for Practice
Limitations of the Study
Future Research
Personal Reflections of the Study

74
74
80
83
84
86
86

Appendix A

Consent to Access Site Form

88

Appendix B

Agreement of Participation Forms, Information Sheet

90

Appendix C

Agreement of Participation Forms, Informed Consent

92

Appendix D

Interview Guide

93

References

96

Chapter 1
INTRODUCTION

Canadian women have entered the labour market and are currently part of the paid
workforce to approximately the same extent as men. The pattern of employment for men
and women is specific to industry. Messing and Stellman (1999) argue that women and
men are not distributed at random over the labour force. Instead, they are segregated into
specific industrial sectors and into female-majority jobs within those sectors. According
to Ostlin (2000) and Hall (1990) working conditions and occupational health problems of
women are less likely to be addressed by employers, unions, researchers and policy
makers.
Discrimination and societal role expectations are the factors most frequently cited to
explain the poor employment outcomes of women with disabilities. Hanna and Rogovsky
(1991) assert that the simultaneous impact of discrimination on the basis of ability and
cultural stereotypes against women can lead to social and psychological barriers in the
transition to employment. The less frequently women with disabilities participate in the
workforce the more cultural stereotypes persist about their roles in society.
Hanna and Rogovsky (1991) and Ziller (1990) suggest that return to work
interventions should take place on two levels: societal (external) and self (internal). With
respect to the work environment (external), there must be changes in discriminatory
practice that contribute to poor self concepts, loss of control, and social participation. At
the internal level, return to work professionals must focus on helping women with

1

disabilities challenge discrimination, reject stereotypical expectations, gain the confidence
to participate in society, and perform new work roles.
Within the workers' compensation system women account for disproportionately
fewer lost time injuries. Chung, Cole and Clark (1998) attribute the relatively lower
claims cost to the legislative constraints and injury reporting processes inherent to the
compensation system. Lippel (1995) argues that women's claims are refused because of
male domination of decision making roles and their gender biases about male and female
expectations of work. Chung et al. (1998) suggest the recognition of gender biases in the
workplace among health professionals and among workers' compensation staff is likely to
result in less frequent delayed reporting, and an increase in accepted claims for women.
The behaviour and goals of men with disabilities are in keeping with the structure of
the compensation system. Ahlgren and Hammerstrom (2000) state: "the most important
factor for return to work after a work related injury, even after controlling for education
and sick leave, is to be a man" (p. 94). Moreover, these researchers found male requests
for assistance were "listened to and supported" yet the requests from women were
considered to be "unrealistic" by the decision makers (p. 88).
Dembe (2001) documents that injured workers generally report negative experiences
with the workers' compensation system. It is perceived to be uncaring, unfair, and
adversarial. Overwhelmingly, the studies support the conclusion that injured workers find
dealing with the system to be the most difficult part of their return to work experience.
This suggests that the gender-neutral approach of legislation and policy contributes to less
attention and fewer resources being directed to the unique needs of men and women
during their return to work.

2

Disability management is a response to rising human and economic costs associated
with the impact of disability in the workplace. It is defined by Shrey and Lacerte (1995)
as "an active process of minimizing the impact of impairment on the individual's capacity
to participate competitively in the work environment" (p.5). Current best practices focus
on anticipating and identifying potential workplace disability incidents, decreasing the
potential for occurrence, and taking steps to minimize the impact disability has on the
individual and the workplace. The shift in managing workplace disabilities, from reactive
past practices to proactive current practices, includes an emphasis on the worker and the
workplace. While there are a range of opinions on what constitutes best practices in
contemporary disability management, case management is a recurrent theme.
In the recent past the Workers' Compensation Board of British Columbia (WCB) has
been criticized for poor performance in delivering efficient and effective return to work
services to injured/ill workers. As a result, in 1996 the WCB adopted an integrated
service improvement strategy with case management at the core of transforming its
services to workers. Consequently, the conceptual model of case management became a
business practice for administering complex claims and moving toward proactively
helping the injured worker get back to work.
Within the Prince George service delivery location of the WCB, the implementation of
case management provides a forum for all the decision makers to develop a return to work
plan for each injured worker. The return to work decisions are influenced by the severity
of the worker's injury, the amount of earnings (wage rate) to be restored, their residual
level of functioning, age of the worker, and their attachment to the employer. At the same
time, all the decisions must be made in accordance with the legislation and policy.

3

Akabas, Gates & Warren (1996) explain that the role of the decision maker is to serve as a
"conduit of organizational policy and procedure" to the worker, as well as the primary
source of feedback to management about the problems and concerns of workers with
disabilities and how workers are responding to their return to work plan (p.27).
Significance of the Study
The patterns of differential exposure and response to occupational injuries and illness
by men and women reflect and reinforce the prevailing inequalities in our society,
experienced by many injured workers as a form of social injustice. Workers receiving
workers' compensation benefits express a profound sense of having been treated unjustly
after a work injury, believing that responses to their condition were frequently
inconsistent, biased, and unethical. For both male and female workers their injury and
rehabilitation can be a life altering experience and current return to work decisions take
little account of this holistic approach.
A review of the literature on gender and compensable return to work reveals a lack of
information specific to how the gender of an injured worker influences the decision
makers within the workers' compensation system. Research is required to bring a greater
understanding of the experiences of decision makers in the workers' compensation system
and bridge a gap in the research literature. While the study is preliminary, it provides a
better understanding of how the phenomenon of gender influences return to work
decisions.

4

Purpose of the Study
Workers' compensation provides no-fault compensation to workers who suffer work
related injuries and disease, and relief for employers from the expense of tort litigation. In
light of this, the Workers' Compensation Board of British Columbia (WCB) is not bound
by legal precedent. Decisions on each claim are made according to the merits and natural
justice of the case. The decision maker examines the evidence to determine whether it is
sufficiently complete and reliable to provide a decision with some confidence. This
judgment is up to the decision maker operating within the law and policy, subject to
review by management or upon appeal.
The purpose of this study is to gain an understanding of the lived experiences of the
decision makers in the workers' compensation system, and how the gender of an injured
worker influences the decision makers and their return to work decisions. My hope is that
the study will also assist the decision makers in identifying their own gender biases. In
turn, this self realization will impact future decision making and thus enhance disability
management practices in the return to work of an injured worker. The study may motivate
the WCB to further research whether a gender-neutral approach in policy and legislation
contributes to less attention and fewer resources being directed to the unique needs of men
and women during the return to work process.
Research Question
The study research questions are based on the central research question: What are the
experiences of decision makers within the WCB in making return to work decisions, and
how does the gender of an injured worker impact these decisions? The study employed a
semi-structured interview where each participant was interviewed individually using

5

probing and open-ended questions. The interview questions focus on experiences, values,
feelings, and perceptions of the phenomenon. Based on my review of the literature, and
my background as a decision maker in the workers' compensation system, the key
interview questions, and sub-questions are as follows:
a) What is your perspective of where your current position/role fits in the return to
work process, from an organizational perspective?
b) What are your experiences with industry alignment? How has industry alignment
impacted your work culture assumptions, workforce stereotypes prior and post
alignment? In your experience, do these assumptions/stereotypes guide your
decisions?
c) What are your experiences with meeting workers? How does meeting with a
worker impact your return to work decision?
d) What are your experiences with case management? What is it about case
management that helps with making return to work decisions?
e) What is your experience with making and delivering a negative decision to a male
injured worker versus a female injured worker?
f) How does it feel when your decisions are challenged by a male injured worker
versus a female injured worker? Is it different, why?
g) What is your experience with who takes more control of the return to work
process, and who is more likely to give control to you?
h) What is your experience with the injured worker and their trust of you and/or the
WCB?
i) What is your experience with the law and policy? How does the law and policy
help you make return to work decisions?
j) Could you describe your sense of self awareness regarding potential gender biases
both professional and personal?

6

Chapter 2
LITERATURE REVIEW
Introduction
Women with disabilities have lower employment rates, attain fewer of their vocational
goals, earn less money, have less job stability, and work in lowered skilled jobs than men
with disabilities. Women with disabilities face 'double jeopardy' also referred to as 'two
handicaps' - being female and having a disability. They are stereotyped in ways that
show no sanctioned vocational roles, few clear role models, and a lack of institutional
means to achieve their return to work goals. Yet Canadian women have entered the
labour market and are currently part of the paid workforce approximately to the same
extent as men. This chapter will explore the gender differences in return to work within
the context of health, social, psychological, vocational, and a workers' compensation
perspective.
Health

Women have always played an important role in the economy. Yet labour market
statistics have primarily focused on paid work and consequently obscured their
contribution to economics. Globally, women's work continues to be domestic in nature.
Hall (1990) argues that domestic work is unpaid work which entails no direct payment, no
protective legislation, no social security, and low social status.
Despite this bias, the increasing visibility and importance of women in the workforce
cannot be ignored. The different roles women and men have in the workforce is an
important factor in understanding gender differences in work and health. Statistics
Canada (2005) reports the participation rate of women in the labour force in Canada

7

increased from 44.4% (1975) to 62.1% (2004), whereas the participation rate of men in
Canada declined from 78.4% (1975) to 73.3% (2004). The participation rate of women in
Canada is greater than that of women in the United States, Japan, Mexico and Australia.
Women make up just less than half (46%) of the total labour force in Canada. Of these,
29% of employed women worked part time in 2004, compared to 10.5% of men. In that
same year, the participation rate of women in British Columbia was 60.6%, compared to
the 70.5%» participation rate of men in the labour force (Statistics Canada, 2005).
Messing and Stellman (1999) suggest that establishing appropriate data bases would
benefit the study of gender in occupational health. For example, many death certificates
do not include information on a woman's profession, in part because once she has retired
she may routinely be considered a housewife. There is also the need to investigate the
health problems in women's traditional work for which strategies have not been
developed. However, there is the likelihood that gender based analyses alone will obscure
other variables and predictors of health related outcomes, such as poverty, age, lifestyle,
and occupation.
Psychological/Social
Ahlgren and Hammerstrom (2000) regard gender as a powerful organizing structure in
society whereby men are in positions superior to women at all levels. This power
inequality has contributed to a cultural view in which different characteristics are
attributed to women than to men. For example, men are regarded as the norm, and
described to as active, logical, and rational. In comparison, woman are described as
passive, emotional, and caring. Subsequently, these traits and values are applied to the
organization of social and working life.

8

Gender inequity is not so much concerned with men and women doing different work,
but that the work is differently valued. Dembe (2001) argues that work disability itself
can be thought of as a complex socially predicated consequence of occupational injury
and illnesses. Even the notion of physical impairment, which is generally considered to
be an objective medical measurement, is subject to social influences. Dembe (2001)
explains that through clinical interviews, the vast majority of physicians consider non
medical factors such as a patient's education, motives, intelligence, personality, and social
environment in determining an impairment rating. Whether or not a person can resume
work after a workplace injury or illness is not determined solely by physical limitations,
but also by a variety of social considerations.
Discrimination and societal role expectations are the factors most frequently cited to
explain the poor employment outcomes of women with disabilities. Hanna and Rogovsky
(1991) describe women's dual disadvantage as a result of discriminatory behaviours
against women with disabilities and of negative stereotypes of women. They assert that
the simultaneous impact of discrimination and cultural stereotypes against women can
lead to social and psychological barriers in their transition to employment. Hanna and
Rogovsky (1991) propose a model of social isolation whereby socio cultural
discrimination, poor self concept, and limited social participation equally influence one
another. For example, the less frequently women with disabilities participate in work, the
more cultural stereotypes persist about their roles in society. Women with disabilities
then internalize those societal messages and develop a poor self concept about their worth
and abilities. A poor self concept limits their confidence and discourages their transition
back into the workforce.

9

Socio-cultural stereotypes result in women with disabilities being unfairly stigmatized.
Hanna and Rogovsky (1991) report that more negative stereotypes and personal blame are
attributed to female images of disability than to male images of disability. For example,
the word 'woman' was associated with concepts of beauty, whereas the term 'disabled
woman' was associated with adjectives such as 'ugly' or 'unpleasant' (p.57). Women
take on the majority of child care and household duties, therefore the addition of full time
work in demanding jobs and careers may lead to excessive life stress for women feeling
conflict about where to concentrate their time. Reed (1999) explains reported stress,
anxiety, and depression related to multiple role conflict to be a larger problem for working
women with a disability than for a working man with a disability.
Brodwin, Parker, and DeLaGarza (1997) describe how women's roles typically fall
into two categories: caretaking roles, which traditionally also have been the vocational
goals assigned to women, and sexual roles. The result of such a devalued status may be a
stigma so severe that women with a disability have been characterized as "roleless"
(p.171). Menz et al. (1989) suggest that role stereotyping leads to:
(a) members of the target group to accept that certain roles are unnatural,
inappropriate, or impossible and that they should not aspire to certain occupations; (b)
the vocational rehabilitation program to accept and guide clients into occupations that are
not feasible

for them; and (c) both individuals and the system to accept the stereotype

as a long term consequence, yielding low vocational goals (p.32).
For a woman with a disability, the transition back to work may result in feelings of
loss of control due to social messages supporting an inability to perform in her work role.
According to Ziller (1990) all people construct self theories based on the information that

10

he or she interprets about him or herself and his/her world in order to predict and control
behaviour. In that regard, a transition back to work due to a disability can result in a
change or uncertainty in one's theory of self.
Self perception and social patterns created during the period away from the workplace
may be determining factors as to whether or not a woman will return to work. Ockander
and Timpka (2003) used a phenomenological approach to explore women's experience of
unemployment during sickness absence. The women who participated in the study
predominantly had a diagnosis of musculoskeletal origin. The common factor among the
women was that their long term sickness absence had disturbed their life plans. The
women who believed they were unable to return to work made changes to adapt to their
new situation of unemployment. Ockander and Timpka (2003) offered the explanation
that women are influenced by other roles, (wife, mother, daughter).
Similarly, Holmgren and Ivanoff (2004) studied 20 women on sickness absence due to
work related strain and their perceived and described possibilities and obstacles for
returning to work. This study illustrates how women go from losing control of everyday
life to mastering life as a whole and finding, or not finding, a way to return to work. Their
relationship with the employer was described as strained with low influence at work and
unsolved conflicts. One major finding of the study was that the participants' description
of personal and work related factors were dependent upon each other.
For both men and women, their acceptance of disability is a step toward their return to
work. Both men and women with a disability must acknowledge the existence of a
disability and learn that the loss of a valued body function does not reduce their worth.
Hampton and Crystal (1999) investigated gender differences and the acceptance of

11

disability. The study concluded that the female participants had a lower level of
acceptance of their disability than the male participants. Bounds, Schopp, Johnstone,
Unger, and Goldman (2003) studied gender differences in a sample of vocational
rehabilitation clients with traumatic brain injury whereby the male participants reported
significantly higher levels of psychological distress following their brain injury than the
female participants. Moreover, the men reported a loss of independence, loss or change in
life role, and difficulty accepting physical changes and limitations as their major
difficulties. The women experienced a loss of autonomy, loneliness, depression,
discomfort in social settings, and decreased interest in sex.
Both Hanna and Rogovsky (1991) and Ziller (1990) suggest return to work
interventions should take place on two levels: societal (external) and self (internal). With
respect to the work environment (external), there must be changes in discriminatory
practice that contribute to poor self concepts, loss of control, and social participation. At
the internal level, rehabilitation providers must focus on helping women with disabilities
challenge discrimination, reject stereotypical expectations, gain the confidence to
participate in society, and perform new work roles.
Vocational
Homgren and Ivanoff (2004) assert that a large obstacle for women with disabilities is
their anxiety of returning to an unchanged work situation. For example, women who
perceived themselves as having a position of influence at work had a decreased sickness
absence. Social support at work was also a predictor of sickness absence. A lack of
support from management and colleagues not only resulted in sickness absence but also
reduced the possibilities for returning to the workplace. The women who participated in

12

the study were mainly white collar women and interestingly noted that they perceived a
low sense of participation and influence at work.
There is a need for employers to provide structured on-site rehabilitation programs
that involve workers and other key stakeholders as soon as possible following an injury.
Shrey (1996) refers to the workplace as the "therapeutic environment of choice" (p. 409)
both in terms of rehabilitation (job accommodations, worksite modification, transitional
work) and prevention activities (safe work practices, ergonomic changes). Auer,
Cunningham, and Jennings (2003) interviewed 22 injured workers (11 male and 11
female) from a range of industries. All the participants had lost time due to injuries and
several had been unable to return to work at all. What emerged from the women's
experience was a description that the workplace represents a form of community and is an
extremely important and affirming aspect of women's lives and their sense of
contribution. The researchers describe this transformation as a "shift of community from
the street to the workplace" (p.42). The women explained that their injury started as a
physical problem and with time impacted their emotional and psychological state, raising
the issues of their identity, role, and self worth.
The behaviour of an injured male worker seems to be more in line with structures in
the rehabilitation/compensation system. Ahlgren and Hammerstrom (2000) state, "the
most important factor for return to work after a work related injury, even after controlling
for education and sick leave, is to be a man" (p. 94). These researchers assert that in
comparison, men are more likely than women to receive a specific diagnosis for their
condition(s). In fact, women experienced more often than men that doctors distrusted
them. Yet, when in contact with the health care system, men demanded more specific

13

investigations in order to find adequate treatment. The women were more inclined to "ask
and hope" for help.
The male way of demanding action from their vocational rehabilitation officer seemed
to be more successful. The requests from men were "listened to and supported" while the
requests from women that asked for non specific help described what the officers
considered as "unrealistic" (Ahlgren & Hammerstrom, 2000, p. 88). The women
experienced that their own suggestions were rejected time after time. Consequently, they
stopped hoping for help from within the system. The women who left the system looked
for alternative solutions, such as applying for a new job on their own. While successful
closures are usually higher from women than for men, Ahlgren and Hammerstrom (2000)
found that these higher rates were a function of the types of allowable closures used with
men and women. For example, women were more likely to enter part time work or return
to "homemaker" status, while men were more likely to enter employment within the
primary labour force.
Menz et al. (1989) suggest that one of the most detrimental forms of gender bias for
women can result from the assessment of a vocational rehabilitation professional.
Although unintentional, the professional's biased assessment may restrict the individual's
considerations of employment and economic options in a more direct and destructive
manner than other forms of discrimination. Patterson, DeLaGarza, and Shaller (1997)
explain that restricted vocational aspirations frequently result from: nature and type of
disability; socialization, which may restrict the range of careers to traditional female jobs;
and limited opportunities for mentors or role models. As a result, it is critical for
vocational rehabilitation professionals to understand a woman's knowledge of

14

occupations, values concerning work, and career aspirations prior to any formal
assessment. For example, an interest inventory will not yield a result if a woman lacks
knowledge of career opportunities or does not view a career path as a viable option.
Therefore, vocational rehabilitation professionals need to evaluate their own attitudes and
gender stereotypes they may possess. As Patterson et al. (1997) recommend, examining
one's attitudes toward gender issues is just as important as examining one's attitudes
toward people with disabilities.
Workers' Compensation System
Within the Workers' Compensation Board (WCB) of British Columbia women
account for disproportionately fewer lost time injuries. In 2004, 72% of all claims,
including minor to traumatic injuries and those occupational disease related, were filed by
males, while the remaining 28% were filed by women (Worksafe, 2005). Chung, Cole,
and Clark (1998) suggest that barriers to reporting injuries and acceptance of claims are
due to biases and pressures among workplace parties, health professionals, and workers'
compensation personnel.
Female workers are consistently identified as having longer durations of work absence
following work related injury than their male peers. The female worker receives workers'
compensation benefits for soft tissue injuries for longer periods than males, and with the
exception of females employed in the construction industry, females in all occupations
have longer durations of work absence following an occupational soft tissue injury
compared to men (Ashbury, 1995). Outcomes of a longitudinal cohort of 148 randomly
selected Canadian workers who had not returned to work three months post injury were
analysed. The rate of return to work for men was 1.5 times that for women, and those

15

men who had modified jobs returned to work at a rate two times higher than those without
workplace accommodations (Crook, Moldofsky & Shannon, 1998).
Female workers have a lower rate of accepted claims than males. Lippel (1995)
conducted a study to investigate other reasons for gender differences in claims rates by
reviewing the accepted and refused claims for psychological stress in Quebec. Among 97
published and unpublished decision on workers' compensation claims for psychological
stress, 51% (25 claims out of 49 claims) filed by women were accepted, compared to 66%
(36 cases out of 55) of claims filed by men. Lippel (1995) suggested explanations for the
women's lower rate of accepted cases included women constituting a minority of
members on both the Review Board and the Appeal panels.
Lippel's (1995) content analysis of legal documents showed that when women
occupied roles stereotypically associated with stress, their cases were often refused on the
basis that stress was 'normal' to that occupation and/or workplace. Moreover, in the
process of adjudication, both men and women were asked about their personal lives as
part of the test of the work relatedness of stress experienced. The study concluded that
often women's claims were refused because of male domination of decision making roles
and gender biased perceptions about work and personal traits. Chung et al. (1998) suggest
that gender biases in the workplace among health professionals and among workers'
compensation staff result in less frequent and delayed reporting, and fewer accepted
claims for women than for men.
Injured workers frequently have little knowledge of the system until they are injured
and it may be difficult to come to terms with these complexities at a time when workers
are already under a great deal of stress. Dembe (2001) reports that injured workers

16

generally report negative experiences with a workers' compensation system that is
perceived to be "uncaring, unfair, and adversarial" (p. 408). This is in keeping with
Cromie, Robertson, and Best (2003) who conducted a qualitative study of physical
therapists with work related musculoskeletal disorders who received workers'
compensation benefits in Australia, and their experiences of the 'system'. All of the 18
participants were female. Participants perceived that their peers would judge them as
being like other compensation claimants; moreover, the participants acknowledged that
their background and upbringing encouraged them to be self sufficient and to manage
without the help of others. When dealing with the workers' compensation system the
participants found it to be "unpleasant" (p. 1086).
Similarly, Canadian workers with work related low back pain have reported feeling
stigmatized as the result of suspicions about the legitimacy of their injuries expressed by
supervisors and coworkers (Dembe, 2001). Overwhelmingly, the studies suggest workers
with disabilities find dealing with the system to be the most difficult part of their return to
work experience.
Decision Making
Beach and Connolly (2005) assert that events seldom occur in isolation, citing the fact
that the decision maker usually has some idea about what led up to them, and what is
going on and why. This form of "framing" involves "observed events in a context that
gives them meaning" (p. 16). Beach and Connolly (2005) argue that when a situation is
framed, the decision maker can make a decision in one of three ways:

17

1. Recognition: situation is so similar to one that he or she has encountered before
that behaviour that worked before can be used again or, at least, a variation of what
worked before can be used.
2. Inference: situation is familiar enough that the decision maker can make an
educated guess about what to do.
3. Choice: situation is sufficiently unique that neither recognition nor inference
provides adequate guidance, and the decision maker must explore his or her
options and choose the promising option(p. 32).
Decision makers who share a similar view of the world, a similar set of beliefs, and
values frame situations similarly. This shared set of beliefs and values is called a culture.
Within an organization the culture consists of a central core of shared beliefs and values.
Beach and Connolly (2005) argue that even if two people frame a problem in the same
way, it does not mean that they will automatically choose the same decision making
pattern. However, if the frames are similar, they can at least understand where the other
person is coming from and can relate to the choice using the same assumptions the other
person is using. Essentially, decision makers who share beliefs and values, and who have
a common experience as a result of a long association with one another, tend to frame
problems in much the same way. As a result, decisions end up being coordinated because
they are predicated on the same set of assumptions. The decision makers are "not to begin
fact finding with any presumption against the worker, nor with any presumption in his/her
favour" (Hunt, Barth &Leahy, 1996, p. 41).
Beach and Connolly (2005) describe a downside to a shared culture in an organization.
Specifically, the range of admissible frames is limited by the culture. Consequently, a

18

decision that threatens and/or violates the organization's beliefs and values is a threat. In
light of this, decisions are made to protect the core values rather than making a positive
move to produce some good or benefit for another (beneficence). Beneficence asserts a
duty or obligation to help others to further their important and legitimate interests.
Keatings and Smith (2000) argue that our individual values influence how we respond
to ethical issues and the decisions we make. Professional values build on and expand our
personal values, and emerge as we are socialized into our specific profession. There are
times when there is a struggle between personal beliefs and professional responsibilities.
Subsequently, value conflicts surface in situations where our actions conflict with our
beliefs. Ethical dilemmas arise when the best course of action is unclear, when strong
moral reasons support each position, and when we must choose between "the most right or
the least wrong" (p. 15).
Normative ethical theories are intended to provide frameworks and rules to guide
decisions about what is right and wrong with respect to actions and behaviours. The two
most traditional categories of ethical decision making are teleological and deontological.
Teleological decision making looks only at the consequences of the action at the time the
action is judged; whereas, deontological decision making looks only at the action itself
regardless of the consequences (Harder & Scott, 2005).
On the other hand, feminist ethical decision making is based on the desire to respond
to each person as an individual. The focus is on caring rather than on justice (Keatings &
Smith, 2000). Rather than treating people equally in the name of fairness, it is recognized
that some people need and want to be treated differently.

19

Not all feminists agree that caring should supersede justice. The concern is the notion
of caring viewed as a gender trait and a survival skill of an oppressed group. Too much
emphasis on the welfare of others, feminists believe, can "drain the resources and energy
of women" (Keatings & Smith, 2000, p. 41). Feminists do not reject the relevance of
caring in decision making, but instead attempt to identify criteria for determining when it
should be offered and when not. Social feminists agree that feelings play a role in ethical
decision making, but that these need to be balanced in relation to social justice. When
making decisions "there is also a need to consider our experiences, the morally relevant
features and responsibilities of the relationships involved, and the context of the situation"
(Keatings & Smith, 2000, p. 41).

Disability Management
Historically, managing workplace disability focused on the objective medical evidence in
search of the right diagnosis and medical treatment, long after an injury had occurred. This reactive
approach to workplace disability left the employer managing the payment of benefits or other leave
options, and the worker with a delayed recovery and return to work. Disability management is a
response to rising human and economic costs associated with the impact of disability in the
workplace. The traditional goal of disability management practice is to return the disabled
individual to work/function. Harder and Scott (2005) explain this definition continues to evolve
and expand to 'comprehensive disability management; the program focus shifts to assisting the
individual to obtain appropriate care and recover to optimal function, and ultimately return to
work. Disability management stresses the importance of recognizing the influences on the worker
that directly impact on the outcomes (p.25). Current best practices focus on anticipating and

20

identifying potential workplace disability incidents, decreasing the potential for occurrence, and
taking steps to minimize the impact disability has on the individual and the workplace. The shift in
managing workplace disabilities, from reactive past practices to proactive current practices,
includes an emphasis on the worker and the workplace. While there is a range of opinions on what
constitutes best practices in contemporary disability management, case management is a recurrent
theme.
As a proactive intervention, case management is most appropriate for persons suffering from
complex or costly injuries where services by multiple providers are required. Ideally, the worker
will return to his/her pre-injury job or a modified/alternate job with his/her employer. Once the
attachment to the labour force is broken, it is far more difficult to return the worker to new
employment. As a best practice, disability case management benefits the worker and the worksite
by focusing on the worker's strengths and needs, facilitating a return to work during recovery, and
organizing resources to implement necessary medical and vocational interventions (Akabas, Gates
&Galvin, 1992).
Case management is a process adopted by health care systems to foster increased quality of
care and decreased cost outcomes. Although case management is a recurrent theme in effective
disability management programs, there is no specific principle and/or process identified as the key
to its success (Dyck, 2000). The context in which case management services are provided is an
important element affecting the outcome of services. Salazar and Graham (1999) suggest the
structure of the system, the characteristics of the service providers, the injured worker, and the
worker's social network may influence how services are provided to workers.
The WCB has been criticized for long delays in rendering decisions, poor communication, and
unclear processes and roles. As a result, the WCB adopted an integrated service improvement

21

strategy with case management at the core of transforming its services to workers. Consequently,
the conceptual model of case management became a business practice to administering complex
claims and moving toward proactively helping the injured workers' return to work. To develop
case management, WCB adopted a prototype approach selecting Prince George as the initial
prototype site.
In both an external disability management program and within the WCB, case management
services are delivered based on core principles. These principles include a focus on early
intervention, return to work planning, and the coordination of resources and services. Where the
principles differ is in the inclusion of multidisciplinary team meetings and site visits found within
the WCB case management model.
The most significant differences in the case management process include assessment and initial
review activities. Assessment as a best practice in the disability case management process includes
identifying the worker's physical and functional status, as well as the resources and/or service
needs (Dees & Anderson, 1996). An appropriate assessment of the worker's needs leads to
appropriate medical treatment, successful recovery, and reintegration into the workforce
(DiBenedetto & Hall, 1995). Certain indicators are used during the assessment phase to identify
potential problem situations requiring case management intervention. Dees and Anderson (1996)
suggest the assessment step is helpful to gather as much information as possible to compare aspects
of the case to the potential problems.
Strong indicators for immediate case management involvement include an expected long
recovery, potential for permanent disability, lost workdays exceeding disability duration
guidelines, and workers with poor employer relations (Dyck 2000). Dees and Anderson (1996)
suggest these 'red flags' also include psychosocial, financial, health, and litigation factors.

22

Assessment and problem identification allow for early identification of potential challenges in the
return to work planning process.
While the initial review activities within the WCB case management model necessitate
gathering information about the worker, the focus of the information is specific to making an
adjudicative decision. For example, this includes information related only to the incident,
treatment, and expected recovery timeframes. While interventions are unique to the worker, they
consider only the 'compensable' effects of the injury, for example, how the injury has impacted the
worker's level of function and ability to return to work. The need for case management
intervention is restricted to the nature of the injury and recovery guidelines. Thereafter, the
worker's return to work plan is developed based on clinical interventions as steps in the worker's
return to work.
A lack of assessment interventions results in the WCB case management process
failure to address the psychosocial issues such as the worker's relationship with the
employer, their fear of change or re injury, lack of worksite support, and concerns about
one's ability to perform their job when developing a return to work plan. Therefore, WCB
case management services do not consider and/or treat the larger scope of diagnosis. The
case management team develops return to work plans within the context of law and
policy, and implements them with an adjudicative focus, as opposed to assessment and
problem identification activities, which focuses on a holistic approach to return to work
planning. These differences in practice suggest the WCB case management process
supports the notion that medical intervention is the only answer to a return to work, thus
failing to recognize the human cost of a disability.

23

When a lengthy work absence is anticipated, case management is required to facilitate
effective early interventions. The length of time workers are absent from the workplace
impacts the likelihood of their return to work. As identified by Bigos, Spengler, and
Martin (1989), workers with a disability face a 50% chance that they will return to work
after a six month absence, dropping to 20% after a one year absence, and only 10% after
two years away from work. Essentially, the longer the worker's absence, the less likely
he/she will return to work. Most importantly, failure to address the human cost of
disability impacts the worker's early return to work and the long term success of case
management intervention. In turn, failure to mitigate the worker's psychological distress
impacts the goal of timely return to work, common to both case management as a best
practice and within WCB.
Problems with the WCB delivery of case management services are rooted in the structure of the
workers' compensation system. Workers' compensation claims are adjudicated in accordance to
the law and policy regulated by the Workers' Compensation Act. Therefore, the administration of
benefits and entitlement to services are determined within defined legal parameters. As a result,
the scope of diagnosis is restricted to what is considered 'compensable'. This means that case
management services can only be provided based on the adjudication of the worker's injury and its
impact on the worker's physical ability to function in his/her pre injury job, within the parameters
of policy.
Exclusive to the goal of the WCB case management model is improved customer service
through regular communication. To achieve the goal of improved customer service relies heavily
on the effectiveness of the decision maker. Salazar and Graham (1999) note that the
communication role is closely linked with "collaboration, negotiation, and facilitation" (p. 419).

24

Similarly, Brines et al. (1999) support that contact by the decision maker to be related to the
worker's satisfaction with how his/her claim is managed. Without a high level of communication
skills, the decision maker can be a barrier to the delivery of efficient return to work services. For
example, poor communication by the decision maker can lead to delays in treatment,
misunderstandings, and inappropriate care for the worker.
Conclusion
Women have entered the labour market and are currently part of the paid work force
approximately to the same extent as men. Yet women with disabilities are less frequently
employed than men with disabilities, and their income is typically lower.
Discrimination and societal role expectations are the factors most frequently cited to
explain the poor employment outcomes of women with disabilities. The simultaneous
impact of discrimination and cultural stereotypes against women can lead to social and
psychological barriers in the transition to employment. The less frequently women with
disabilities participate in the workforce, the more cultural stereotypes persist about their
roles in society. There must be changes in discriminatory practices that contribute to poor
self concepts, loss of control, and social participation. At the same time, return to work
professionals must focus on helping women with disabilities challenge discrimination,
reject stereotypical expectations, and gain confidence to participate in society and perform
new work roles.
The patterns of differential exposure and response to occupational injuries and illness
by men and women reflect and reinforce the prevailing inequalities in our society
experienced by many injured workers as a form of social injustice. In general, workers
receiving workers' compensation express a profound sense of having been treated unjustly

25

after a work injury, believing that responses of the decision makers to their condition were
frequently inconsistent, biased, and unethical. For both male and female workers with a
disability, their injury and rehabilitation is a whole of life experience and current practice
takes little account of this holistic approach.
Case management is a process adopted by health care systems to foster increased
quality of care and decreased cost outcomes. Although case management is a recurrent
theme in effective disability management programs, there is no specific principle and/or
process identified as the key to its success (Dyck, 2000). Salazar and Graham (1999)
suggest the structure of the system, the characteristics of the service providers, the injured
worker, and the worker's social network may influence how services are provided to
workers.
Within the structure of the WCB, the delivery of effective decision making is affected by the
restrictive nature of law and policy, and the skills and ability of the decision maker involved in the
implementation of services. As a result, the implementation of case management within the WCB
fails to recognize the worker and the workplace as active participants in the long term success of
return to work. While the case management model within the WCB supports the notion of
workplace based disability management programs, to make an impact on the economic and human
costs of disability requires an organizational change. Notably difficult, the change must be
conducive to mitigating the worker's reaction to psychological distress and maintaining the
worker's connection to the workplace from recovery through to return to work.

26

Chapter 3
RESEARCH METHODOLOGY

The research design for this study is based on qualitative methods. Creswell (1998)
defines qualitative research as an inquiry process of understanding based on distinct
methodological traditions of inquiry that explore a social or human problem. The
qualitative researcher builds a complex, holistic picture, analyzes words, reports detailed
views of informants, and conducts the study in a natural setting. The qualitative
methodology of the study will employ a phenomenological mode of inquiry.
Orientation of the Study
Phenomenology is concerned with the study of experience from the perspective of the
individual. Moustakas (1994) explains the aim of phenomenology is to "determine what
an experience means for the persons who have had the experience and are able to provide
a comprehensive description of it" (p. 13). Similarly, McMillan and Schumacher (2001)
describe that the aim of phenomenology is to transform lived experience into a description
of "its essence in such a way that the effect of the text is at once a reflexive reliving and
reflective appropriation of something meaningful" (p. 36).
A phenomenological study describes the meaning of the lived experiences for
individuals about a concept or a phenomenon (Creswell, 1998; Van Manen, 1990). The
phenomenologist searches for the essence or the central underlying meaning of the
experience and emphasizes the "intentionality of consciousness where experiences contain
both the outward appearance and inward consciousness based on memory, image, and
meaning" (Creswell, 1998, p.52). Accordingly, the phenomenologist explores the

27

structures of consciousness in human experiences by using inductive data collection tools
such as interviews, discussions, and participant observations (Creswell, 1998).
During the methodology phase of data collection and data analysis I was employed
by the WCB as an Account Manager/Client Services Manager. The scope of my role
included working with employers to assist them in developing effective return to work
programs at their worksites. As such, there was no direct reporting relationship with the
participants in the study within the scope of my role as a manager. During the
methodologies phase of the study I was on an educational leave from my employment,
which further helped with the delineation of my researcher role from my decision maker
role. I reflected on my own experiences as a decision maker with the phenomenon of
gender and maintained a field journal as a record of my personal reactions to the findings
in the data.
Moustaksas (1994) reinforces the view of acquiring new knowledge, "as an experience
in itself, a process of setting aside predilections, prejudices, predispositions, and allowing
things, events, and people to enter anew into consciousness, and to look and see them
again, as if for the first time" (p. 85). McMillan and Schumacher (2001) assert the
researcher "brackets" or puts aside all prejudgments and collects data on how individuals
make sense out of a particular experience or situation (p.36). I approached this study with
an open mind, putting aside my prejudgements and biases based on my experiences as a
decision maker, as well as my professional relationship and familiarity with the decision
makers in the chosen sample.

28

Research Site
Creswell (1998) asserts that in a phenomenological study, the participants may or may
not be located at a single site. Most importantly, they must be individuals who have
experienced the phenomenon being explored and can articulate their conscious
experiences. The research site for the study is the Prince George service delivery location
of the WCB of British Columbia. The delivery location includes two departments,
prevention and claims. The prevention department includes a total of 8 Occupational
Health and Safety Officers and 3 Occupational Hygiene Officers whose primary function
is to ensure employers are complying with the health and safety regulations specific to
industry. The focus of the claims department is to assist injured workers to return to work
and/or to lessen the barriers resulting from their disability. There are a total of 46 people
employed in the claims department, including twenty one administrative staff, 4 medical
advisors and twenty one decision makers. The study participants are decision makers
within the claims department.
This location is the work place of the sample of decision makers participating in the
study. Gaining entry into the field requires establishing good relations with all individuals
at the research site (McMillan & Schumacher, 2001). I have been employed at the
research site for six years. I have professional relationships with all the participants in the
study.
In qualitative research, you often need to seek and obtain permissions from individuals
and sites at many levels (Creswell, 2005). Creswell (2005) recommends identifying a
"gatekeeper" as the individual with an official or unofficial role at the site. Formal
permission to conduct interviews at the site was obtained from the WCB local

29

management. They were provided with documentation outlining the central purpose of the
study and the procedures to be used in the data collection, information about protecting
the confidentiality of the participants, and the length of time required to collect the
information at the site. For reference, I have enclosed Appendix B Consent To Access
Site form.
The chosen research site was ideal considering my stated research problem and
purpose. In addition, entry to the site is easily obtained as it is the natural setting in which
the phenomenon takes place. Moreover, the participants are familiar with the setting, and
it provides for an environment in which I have trusting relationships with the participants
in the study.
Study Participants
The research term used for qualitative sampling is purposeful sampling (Creswell,
2005). Purposeful sampling is a strategy that chooses small groups or individuals likely to
be knowledgeable and informative about the phenomenon of interest (McMillan &
Schumacher, 2001). I intentionally selected a sample of participants to learn or
understand the central phenomenon of the study. The population sample consisted of eight
'decision makers' employed by the WCB, who are located at the Prince George service
delivery site.
Of the 16 strategies for purposeful sampling advanced by Miles and Huberman (1994),
this study employs criterion sampling. Creswell (1998) asserts "criterion sampling works
well when all individuals studied represent people who have experienced the
phenomenon" (p. 188). Each participant in the study is considered a 'decision maker'.
That is, each participant has decision making authority to administer specific sections of

30

the Workers' Compensation Act within the scope of return to work of injured workers in
British Columbia. Depending on the role of the decision maker in the return to work
process, their decision making authority is guided by specific and differing sections of the
Act. Therefore, the sample of eight participants is representative of all levels of 'decision
makers' in the return to work process as follows: two Entitlement Officers; two Case
Managers; two Vocational Rehabilitation Consultants; and two Managers. Each decision
making role consists of one female and one male decision maker. The decision makers
selected for the study have maintained their decision making role for 5 years with the
WCB. Each decision maker is aligned to industry specific employers located throughout
British Columbia.
Data Collection Process
In qualitative research detailed information is gathered in order to establish the
complexity of the central phenomenon (Creswell, 2005). A qualitative researcher asks
one or more participants general, open ended questions so participants can best voice their
experiences unconstrained by any perspectives of the researcher or past findings
(Creswell, 2005). The phenomenological mode of inquiry involves primarily in-depth
interviews (Creswell, 1998). The phenomenological interview is an informal, interactive
process that utilizes open-ended comments and questions (Moustakas, 1994). For the
purpose of the study, individual in-depth interviews with the participants provided useful
information regarding the phenomena which cannot be directly observed, and allowed for
participants to describe their experiences.
This study employed the semi-structured interview data collection technique. Each
participant was interviewed individually using probing and open-ended questions. The

31

study included interview questions focusing on experiences, values, feelings, and
perceptions of the phenomena. Each interview was prescheduled at a mutually agreed
upon date and time, and was held at the Workers' Compensation Board, Prince George
service delivery location. The interviews took place in a private office, free of
distractions. The interviews were audio taped and subsequently transcribed.
Qualitative in-depth interviews are noted more for their probes and pauses than for
their particular question formats (McMillan & Schumacher, 2001). In the interview guide
approach, topics are chosen in advance but the researcher decides the sequence and
wording during the interview (McMillan & Schumacher, 2001).
Ethical Considerations
A qualitative researcher conveys to participants that they are participating in a study,
explains the purpose of the study, and does not engage in deception about the nature of the
study (Creswell, 1998). As the researcher, I provided information to the participants
regarding the purpose of the study, the potential benefits and risks in participating in the
study, and how and why they were chosen to participate. Please see Appendix C
Information Sheet. A consent form includes the participant's right to voluntarily
withdraw from the study at any time, the purpose of the study and procedures to be used
in data collections, protection of confidentiality, consent to known risks and benefits
associated with participation in the study, and access to the information they provide.
Please see Appendix C Informed Consent Form. The participants were provided with the
opportunity to ask questions.
Researchers have a dual responsibility: protection of the participants' confidences
from other persons in the setting whose private information might enable them to identify

32

them, and protection of the informants from the general reading public (McMillan &
Schumacher, 2001). As the researcher, I protected the anonymity of the participants by
eliminating identifiers such as names of the participants and individual job titles within the
WCB. The participants were provided information regarding confidentiality and
anonymity through both dialogue and documentation. The participants were not offered
any financial inducements to participate in the study. The transcriptionist was required to
sign a Transcriber Confidentiality Agreement agreeing not to discuss the information on
the audiotapes with any person other than myself.
The researcher cannot anticipate everything, but "she must reveal an awareness and
appreciation of and commitment to ethical principles for research" (Marshal & Rossman,
1995, p. 73). As the researcher, I anticipated more routine ethical issues such as
beneficence and non-maleficence. The principle of beneficence asserts that one must
make a positive move to produce some good or benefit from another (Keatings & Smith,
2000). This study will benefit the decision makers as an advancement of knowledge, as
well as the WCB as an organization. The principle of non-maleficence obliges the
researcher to act in such a way that we prevent or remove harm (Keatings & Smith, 2000).
As the researcher, the data is reported honestly without changing or altering the findings
to satisfy certain predictions or the WCB. I will make every effort to communicate the
practical significance of my research to the participants, other decision makers within the
WCB, and the policy and research department at the WCB.
Storage of the data reflects the type of information collected, which varies by tradition
of inquiry (Creswell, 1998). The data from this study will remain in locked storage at the

33

University of Northern British Columbia for one year following completion of my thesis.
Thereafter, the data will be destroyed.
Data Analysis
Analyzing qualitative data requires understanding how to make sense of text and
images so that one can form answers to ones research questions (Creswell, 2005).
Qualitative data analysis is primarily an inductive process of organizing the data into
categories and identifying patterns (relationships) among the categories (McMillan &
Schumacher, 2001). Qualitative research employs inductive data analysis going from the
particular (detailed data) to the general (categories and themes). Categories and themes
emerge from the data rather than being imposed on the data prior to collection.
Creswell (1998) asserts the qualitative researcher begins with a full description of his
or her own experience of the phenomenon. Subsequent steps in the phenomenological
analysis approach identified by Creswell (1998) require the researcher to: identify
statements in the transcript about how the participants are experiencing the topic; list out
these significant statements; parallelism of the data; treat each statement as having equal
worth; work to develop a list of non repetitive, non overlapping statements; group the
statements into 'meaning units' and use these units to write a description of the
experience. This process is followed by a written "composite" description of the
researcher's account of his/her experience and of the experience of each participant
(p.150).
After each interview, the audio tapes were forwarded to a transcriptionist for the
purpose of converting the interview into text data. Once the transcription was received the
tapes were placed in a locked storage at the University of Northern British Columbia.

34

The data analysis process began by obtaining a general sense of the data. Creswell
(2005) describes a preliminary exploratory analysis in qualitative research consists of
"exploring the data to obtain a general sense of the data, memoing ideas, thinking about
the organization of the data, and considering whether you need more data" (p. 237). As
the researcher, I read the transcripts in their entirety to ensure they were accurate and to
get a sense of the interview as a whole, before breaking it into parts. This included
writing notes in the margins of the transcripts.
The inductive process of narrowing the data into a few themes led to the coding
process in my data analysis. The objective of the coding process is to "make sense out of
the text data, divide it into text or image segments, label the segments with codes,
examine codes for overlap and redundancy, and collapse these codes into broad themes"
(Creswell, 2005, p. 237). Once I coded the entire text, I selected specific data to use and
data that did not specifically provide evidence was disregarded. Similar codes were
grouped and reduced to a list of more manageable number of themes. Subsequently, I
revisited the data to identify whether new codes emerged, and to identify specific quotes
from participants that support the codes (Creswell, 2005). I reduced the list of codes into
themes or descriptions of the major ideas from the data. Describing and developing
themes from the data consists of answering the major research questions and "forming an
in depth understanding of the central phenomenon through description and thematic
development" (Creswell, 2005, p. 241). Moustakas (1994) asserts the final challenge of
phenomenological reduction is the construction of a complete textural description of the
experience.

35

Throughout the process of data analysis, the researcher must ensure the findings and
interpretations are accurate. The data was recorded mechanically with a digital tape
recorder to provide an accurate and relatively complete record. Validity refers to the
degree to which the explanations of the phenomena match the realities of the world
(McMillan & Schumacher, 2001). The authors assert that verbatim accounts of
conversations, transcripts, and direct quotes from documents are highly valued as data.
The study includes direct quotations from the data to illustrate the participants' meanings
of their experiences. McMillan and Schumacher (2001) define low inference descriptors
as "descriptions that are almost literal and important terms used and understood by the
participants" (p. 409). The study uses concrete and precise descriptions from the
transcripts as the principal method of identifying patterns in the data.
Creswell (2005) explains that validating findings requires the researcher to determine
the accuracy or credibility of the findings through strategies such as member checking or
triangulation. The data were triangulated from each individual interview and compared to
the literature to ensure the report is both accurate and credible. To "check the findings" I
presented the findings back to the participants and asked them about the accuracy of the
report, whether the description was complete, and if the themes include "fair and
representative interpretations" (Creswell, 2005, p. 252).
Reflexivity is valued as a very important procedure for establishing validity.
McMillan and Schumacher (2001) define reflexivity as a rigorous self scrutiny by the
researcher throughout the entire research process (p. 411). As the researcher, rather than
deny any subjectivity, I self monitored to ensure I built trust with the participants, was non
judgemental, respected the norms of the situation, and maintained sensitivity to ethical

36

issues. I maintained a journal through out the data analysis as a continuous record of my
decisions, evolution of ideas, and data management techniques for audibility purposes.
For Moustakas (1994) establishing the 'truth of things' begins with the researcher and
their perception. One must reflect, first, on the meaning of the experience for oneself;
then, one must turn outward to those being interviewed, and establish "inter subjective
validity" (p. 57). McMillan and Schumacher (2001) assert the most important strategies
to monitoring researcher subjectivity and perspective are keeping a field (reflux) journal
and documenting for audibility. A field (reflux) journal is a continuous record of
"decisions made during the emergent design and the rationale at the time" (p. 413). As
the researcher, I maintained a record of any modifications and reformulations of the
research problem and strategies, evolution of my ideas, and personal reactions through out
the methodology of the study. Audibility requires "maintaining a record of data
management techniques and decision rules that document the chain of evidence or
decision trail" (p. 413). I maintained a record of all my data management techniques,
codes, categories, and themes as evidence available to an outside reviewer to check for
accuracy of the documents that link the findings to the original sources.
Report Writing
Moustakas (1994) presents a guide to developing a manuscript that effectively
organizes and presents a phenomenological study. The guide suggests the manuscript be
presented in the following chapters: introduction and statement of topic and outline,
review of the relevant literature, the presentation of data, summary, implications and
outcomes. I used this format for the written report of my completed thesis.

37

Creswell (2005) asserts the primary form for representing and reporting findings in
qualitative research is a narrative discussion. The study is presented in a written format
summarizing, in detail, the findings from my data analysis. The study includes: dialogue
that provides support for themes; quotes from the interview data is written with vivid
detail and reports; the multiple perspectives of the decision makers as well as any tensions
or contradictions in individual experiences (Creswell, 2005). As recommended by
Creswell (2005), a "Discussion" section is included in the report describing the major
findings of the study. This complements the more detailed description and theme
passages within the report.
Qualitative research requires the researcher to interpret the findings. Creswell (2005)
reports "interpretation requires the researcher steps back and forms some larger meaning
about the phenomenon based on personal views and/or comparisons" (p. 251).
The report includes a section with the heading "Interpretations" with a review of the
study's major findings, how the research questions were answered, my personal
reflections about the meaning of the data, my personal views compared and/or contrasted
with the literature, limitations for the study, and suggestions for future research.

38

Chapter 4
FINDINGS AND DISCUSSION
This chapter includes dialogue that provides support for themes and quotes from the
interview data. It is written with vivid detail and reports the multiple perspectives of the
decision makers as well as any tensions or contradictions in individual experiences
(Creswell, 2005). To better understand the participants' experiences, I read the transcripts
in their entirety several times to ensure their accuracy. This allowed me to immerse
myself in the data and gain an in depth understanding of the central phenomenon.
Creswell (1998) asserts that the phenomenological analysis approach requires the
researcher to: identify statements in the transcript about how the participants are
experiencing the topic; list out these significant statements; treat each statement as having
equal worth; work to develop a list of non repetitive, non overlapping statements; group
the statements into 'meaning units' and use these units to write a description of the
experience. The verbatim accounts in the transcripts and direct quotes are accurate
descriptions of the major ideas and helped identify patterns in the data used to arrive at a
central theme, and five major themes with several minor themes subsumed within the
major concepts. The major themes and sub-themes are: understanding the decision
maker, including the decision making approach, stereotyping the injured worker, framing
the return to work decision, gender of the decision maker, and self awareness; the injured
worker, along with trust, and control of return to work; communication, including meeting
the injured worker, and delivering the return to work decision; case management, with

39

subsuming themes of team, introduction of psychological-social issues, and severity of
injury; and lastly, law and policy with subsuming themes of neutrality and value conflict.
Findings
Role in return to work
Both entitlement officers identified their decision making role being at the "front end
of the claim", with a decision making focus on the investigation of available and suitable
modified duties at the worksite:
We are there to say whether or not modified duties are appropriate, perhaps to
organize those modified duties, to bring them to the employer's attention, certainly
bring them to the worker's attention and to start the process.
The case managers reported educating workers on the claims process, recovery, and
the benefits of return to work. This is illustrated in the following two quotes:
1. The role of return to work is front and center because we're meeting with the
worker so we're providing education, not only collecting information in order to
adjudicate a claim, but also providing education and information about the claim's
process, about the recovery process and about the benefits of work and staying at
work.
2. A great opportunity to educate and set some expectations on the routing of the
claim to another officer, the goal of return to work as soon as possible in a healthy and
safe manner.. .If not to the worker's pre-injury job then to something modified,
appropriate and productive.

40

A vocational rehabilitation consultant described getting involved as soon as it becomes
apparent the worker may have difficulty returning to the job he/she was doing at the time
of injury through to helping the worker find new employment:
I get involved when it's evident or becomes evident that there may be difficulty with
the person returning to their pre-injury job. To help them find some other type of
employment, should they be unable to go back to the job they had when they got hurt.
A client service manager shared his/her experience with a legislative change in 2002
which impacted the managers' involvement in the return to work process. According to
this client service manager, the implementation of the legislative amendment shifted
his/her decision making involvement earlier in the return to work process:
Before there was a manager review process written into the legislation and policy
where we [client service managers] formally reviewed claims and had the ability to
change the decisions on them after the fact. With the change in legislation the
manager review process was removed with the intention that the managers would
work with the decision maker before they make the decisions so that it's more
collaborative as opposed to legalistic. So while there is still some judgment
involved it is more collaborative judgment as opposed to legal judgment.
Training
While the nature of training varied depending on the position of the decision maker,
all the participants reported law and policy as the focus of their formal classroom training.
All the decision makers indicated they received no training on communication,
psychological-social impact of unemployment, and/or ethics in decision making.

41

Both entitlement officers reported that their classroom training centered on law and
policy and its application. One entitlement officer described," law and policy is
specifically what it is about, how to interpret the law and policy and apply it". Similarly, a
vocational rehabilitation consultant reported his/her training focused "on the policy of the
Board, law and legislation."
A case manager described his/her training centered on "claims management", with a
focus on law and policy. This participant explained it was not until he/she was assigned
work and back at their desk did they actually start to "learn the job".
The client service managers both reported having received no initial training for their
current positions. One manager reported having participated in training courses on their
own initiative, as part of their professional development:
Initially I received no training, I received a half hour orientation and then as the years
have gone by I've had some training courses on things like project management and
diffusing hostility.. .as a manager I have had no specific training at all for management
functions.
Central Theme
Each participant has decision making authority to administer specific sections of the
Workers' Compensation Act within the scope of return to work of injured workers in
British Columbia. Depending on the role of the decision maker in the return to work
process, his/her decision making authority is guided by specific and differing sections of
the Act. Through data analysis and a review of the participants' stories, I gained an
awareness of the central or core theme within the data. All the decision makers recognize
the value of work for both the female and the male injured worker. Despite their role in

42

the return to work process, the decision makers recognize the human and financial
benefits of maintaining the injured worker's attachment to the employer. The stories of
the participants illustrate their commitment to providing return to work interventions early
and maintaining the injured worker, despite gender, at work. This was reflected in all the
major themes that emerged from the data.
Major Themes and Sub-themes
Understanding the Decision Maker
Decision making approach
When asked to describe their decision making style, anywhere from purely
adjudicative (legalistic) through to discretionary, all the participants reported exercising
some discretion in their decision making. The degree of discretion varied based on the
participants perceived constraints imposed by law and policy on making return to work
decisions. One participant described discretion as a "privilege":
You want to make the best-reasoned decision in line with law and policy. Some
areas you can use some discretion in, some areas you don't have that privilege.
Sometimes some factors that come into play there is some discretion that is
warranted that does not take away from the application of law and policy.
Conversely, a participant viewed discretion in decision making as a rule, with a less
rigid view of the constraints of law and policy. This is illustrated in the following
quote:
I look at the evidence and it's a game of give and take sometimes. You have to
know what to push and what not to push. I don't lose a lot of sleep over the small
things. At the end of the day that is not going to help and it's not going to change

43

the return to work outcome. So my style is more one of trying to make things work.
Maybe on the fringes of law and policy sometimes.. .You have to be reasonable at
the end of the day.
Similarly, a participant reported the law and policy as secondary to the application
of discretion in making effective return to work decisions. This participant described
how he/she "works backwards" in making return to work decisions, by first exercising
discretion and then applying law and policy:
I come up with a goal or direction first and then work backwards to see how I might
be able to make that direction work within the parameters of the rules I have to work
within.
Two participants described their observed shift in decision making approaches
amongst the decision makers in the organization [WCB]. One participant described the
shift as a move from an adjudicative, law and policy evidence based approach, to a
holistic whole person approach. This is illustrated in the following quote:
When I became an adjudicator [decision maker] initially, it was all about the
evidence. Everything was about evidence, and making the decisions on the
facts.. .the evidence and not really focusing on perhaps so much the client's needs as
making the decision and making it fast. In today's world it's more, holistic, the
whole body, the whole person and taking into account all of their problems or
anything that might impact the return to work and having to deal with them as a
whole person. You still have to make those tough decisions sometimes but you
always try and look at the whole person.

44

The literature does not address decision making processes and/or approaches of the
return to work decision makers within a compensation environment.
Stereotyping the worker
The decision makers' experiences varied with stereotyping of the female and male
injured worker. All the participants are decision makers assigned to a specific industry
and/or employer in the province. The decision makers are responsible for all the claims
generated due to occupational illness and/or injury by a specific employer. The following
two quotes illustrate the experience of those participants whose stereotypes of the male
worker is impacted by the implementation of industry alignment:
1. At first I thought these guys were poorly educated, physically fit, warm bodies
performing the function.. .big lugs with no education. Now I know there are a lot of
young workers out there who are going to school or who have degrees, who this is an
in between, make a lot of money type of job. A lot of the oil and gas secondary
services are well educated guys who have gone through stringent testing to get the
jobs that they have. These guys are well trained and educated.

2. I have been surprised on many occasions of how intelligent and how sophisticated
the industry [oil and gas] actually can be. It's not just about drilling a hole in the
ground, there is a lot more involved to it. There is a significant amount of money and
intelligence overseeing every aspect of what's going on out there.
Those participants who described no shift in their stereotypes of the injured worker
were decision makers with varied exposure to their assigned industry prior to industry
alignment. One participant who worked as a summer student at a local sawmill, with

45

exposure to a predominantly male workforce described, "they [male workers] range from
what one would call a typical stereotype to the opposite where the workers are educated
and only working at a mill because they need to."
The findings support Messing and Stellman's (1999) assertion that women and men
are segregated into specific industrial sectors and into female and male majority jobs
within those sectors. The literature supports that the simultaneous impact of
discrimination and cultural stereotypes against women can lead to social and
psychological barriers in their transition to employment.
The low participation rate of women in industry may be a contributing factor to no
reported experiences with stereotyping of female workers. For example, Hanna and
Rogovsky (1991) assert that the less frequently women with disabilities participate in
work, the more cultural stereotypes persist about their roles in society. Women with
disabilities then internalize those societal messages and develop a poor self concept about
their worth and abilities.

Framing the return to work decision
All the participants were asked about their experiences with industry alignment and
how their familiarity with the assigned industry impacts their return to work decisions.
All the participants believed their increased knowledge of the jobs performed by the
workers and a strong relationship with the employer contributed to a more informed and
familiar decision making process. Despite their familiarity with the industry and the
employers, all the decision makers described the circumstances of the individual worker

46

as paramount to making effective return to work decisions. The following two quotes
illustrate this:
1. I know what the jobs in my industry are by now. There is not a lot of ambiguity in
my brain about what jobs entail, so I don't need to go out every time and see the same
guy doing the same thing. I've been to enough job sites to be able to generalize those
jobs. But the individuals I can't generalize. It used to be the stereotypical guy who
was a farm boy that left the farm.. .but that's not what I seem to see anymore. There
are lots of people with university degrees paying off student loans, or trying to get the
money for a down payment on a house, or kick start their career, or older fellows who
have left the logging industry... I have to know something about them. I can't just
assume that he's going to be like everybody else because they never are.. .they come
from backgrounds that I hadn't anticipated, or they're there for reasons that aren't as
obvious as I thought at first.
2. It's their [worker] attitude and the worker environment. But if the work
environment is the same, two people with the same injury, exactly the same date [of
injury], you likely will not get them back to work at the same time because of the
individual.
Beach and Connolly (2005) argue that when a situation is framed the decision maker
can make the decision either by recognition, inference or choice. The reported
experiences of the participants support that their return to work decisions are made by
choice in that, "the situation is sufficiently unique that neither recognition nor inference
provides adequate guidance," (p. 32).

47

A participant describes his/her experience working with decision making peers who
share a similar set of beliefs and values and who frame their return to work decisions
similarly:
We have to look at every claim on its merit. From time to time somebody will say, oh
I just had a claim just like that and this is what we decided to do. I have to bring it
back, my job is to bring it back, say well wait a minute, this is a different client. What
do we know about this client and those working conditions versus the other client,
what is different about their physical makeup and their personal makeup.
Beach and Connolly (2005) assert that even if two people frame a problem in the same
way, it does not mean they will automatically choose the same decision making pattern.
However, if the frames are similar, they can at least understand where the other person is
coming from and can relate to the choice of the decision maker using the same set of
assumptions.
Gender of the decision maker
All the female decision makers reported experiences when they had been stereotyped
by the injured worker, specifically the male worker. Conversely, the male decision
makers reported no experiences of feeling stereotyped by the injured worker. The
literature does not address how the injured workers' stereotype of the decision maker
influences the decision maker and their return to work decisions.
The female participants explained how difficult it can be to combat the attitudes of the
male injured workers. Two participants perceived the stereotype as primarily due to being

48

a woman in a position of power. The following quote illustrates the experiences of these
decision makers:
It's a matter of what their perception is of where men and women stand in the whole
hierarchy of life. There are some claimants who are very distressed by the fact that
I'm a woman and I'm making a decision on their claim. They're from Fort St. John
and they've got a grade eight education and have been running machinery all their life.
They make a hundred grand a year or more and they have this certain attitude in place
about you, a woman telling me what's going on with my life, and then you're not
really focused on their return to work really.. .You haven't been able to break through
the barrier of what I might represent to them even as a woman.
Another female participant attributed the stereotyping of female decision makers to the
worker's exposure to the WCB. She explained that the injured male worker typically
works in an industrial workplace and is most often in contact with the WCB through a
prevention officer. The role of the prevention officer is primarily compliance focused
with a long standing relationship with the employer developed at the worksite. There are
nine prevention officers in the Prince George service delivery location, all of whom are
male. This participant reported her experience with male workers when they first discover
she is a decision maker:
I think all the workers are used to seeing prevention officers, and the majority of them
are male. So they get use to that role. And sometimes when they see a woman that's
in the office they tend to think that you must be clerical, you must be somebody who
is a receptionist. So when you say to them I am going to be making decisions about

49

the type of job that you do and whether you can return to that they might be surprised
by that.
Another participant reported how feeling stereotyped by a male injured worker impacts
her return to work decision:
Sometimes that might distract me from investigating something or I'm missing a piece
of information that I really could use. But I've been distracted and I'm not going to
gather it, so maybe, subconsciously it might affect the decision.
Many of the participants commented on how they felt the gender of the decision
maker has an impact on making return to work decisions. A female participant speculated
that a male decision maker could not achieve the same success with return to work as a
female decision maker working with a predominantly male industry. She described the
positive influence a female decision maker has on a male injured worker:
It's a predominantly male industry, they don't deal with females very often, and if I'm
chatty Cathy with them, it's that they have been more apt to be receptive to a return to
work than if I had been a male telling them to go back to work.. .It's them [worker]
has a perception of me. That gives me the ability to open up my arsenal as to how to
influence them back to work. They allow that to happen. A male in my position could
not do that. If I were a male I am not going to talk to them and ask them if they've
been doing Christmas cookies or doing Christmas cards, like that sort of talk isn't
going to go over with male versus male.
Two participants reported where the gender of the decision maker was the same as the
gender of the worker, the return to work decision was compromised, due primarily to the

50

decision makers' lack of understanding of the worker. A participant described her
experience of male decision makers working with male workers as a situation where the
worker gets "a little bit of a break":
We have a couple of [decision makers] males, who come from a very highly educated
background and never worked in any kind of laboring occupation or blue collar type
work or anything physical so to speak. My experience has been that sometimes
they're perhaps not as understanding of what can go on in the industries or sometimes
that could be good or bad, sometimes they might believe that the work must be tough
therefore gives this client a little bit of a break because it has to be a tough job because
all they know, their knowledge and experience is in the office.
Conversely, a male participant comments on how female decision makers are "harder on
women workers":
It's almost like there's less sympathy sometimes from the women, especially on return
to work, which is odd, because you'd think they would have more identification and
understanding of the whole picture of what a woman deals with. It is not uncommon
for me to get complaints from workers regarding our decision makers who are women
that they were not nice to them.

Self awareness
All the male participants reported making return to work decisions for a female
injured worker as requiring greater attention for potential gender bias as compared to the
male injured worker. Two of the male participants described their experience making

51

return to work decisions for "attractive" female injured workers required heightened
awareness for potential gender bias. This is illustrated in the following two quotes:
1. I have them [female workers] come in and they're young and attractive, and I'm
going wow to be honest with you I feel an attraction for them. Sometimes it can be
a mutual thing and you pick up on it and I have to check myself and go, bing... I
acknowledge it inside but it doesn't impact at the end of the day what I need to do.
2. I think I have a high awareness. I hate to even say this... I seem to be susceptible
to really pretty girls, women, attractive women. I would assume that it's never a
affected a decision, but I've even asked others and so on if I'm seeing it fairly.
The third male participant described how his self awareness for potential gender bias
results in making better return to work decisions:
I'm aware of gender bias being real. I mean I was raised by a single mom so a lot of
men are now, so I think my generation is becoming more neutral in our thinking than
my dad was and my grandfather. So I think in that way, I'm better at this job than
they were and the person before them. I'm used to being around women, I'm not
uncomfortable with it, it doesn't matter. I think that if you're not aware of it then
maybe you have lots of potential for major bias. But if you are aware of it, then you
always have to check yourself and make sure you're doing the right thing.
These findings correspond with Chung et al. (1998) who assert that the recognition
of gender biases in the workplace, among health professionals and among workers'
compensation staff, is likely to result in less frequent delayed reporting, and an increase in
accepted claims for women. These findings are consistent with Patterson et al. (1997)

52

who explains how examining one's attitudes toward gender issues is as important as
examining one's attitudes toward people with disabilities.

The Injured Worker
Trust
All the participants agreed there is a worker distrust of the system [WCB]. Dembe
(2001) asserts that injured workers generally report negative experiences with a workers'
compensation system that is perceived to be "uncaring, unfair, and adversarial" (p. 408).
A participant reported that it is incumbent on the decision maker to "overcome the
system" in order to achieve the trust of every injured worker:
I might be able to establish trust with them on a personal level. I will have to
overcome the system to do that. I have to make a real effort to listen to them, and
explain it to them more than I would have expected to. I don't find that many people
come to the table saying I trust you and I trust the system. They come to the table
saying, I don't trust you and I don't trust the system.
A participant explained how the worker's distrust is due primarily to his/her length of
time on claim, experiences while on claim, and understanding of the return to work
process:
I think that the longer they've been in the system the more biases there are towards the
system, and the more antagonistic and difficult the whole process is, whether they're
male or female. People who are not familiar with the whole process seem to be quite
trusting and I think if they had a good experience before me... and it's been positive

53

then generally we start out positive, and if it's been really antagonistic then I have to
deal with that up front, whether they're male or female.
This corresponds with Dembe (2001) who reports injured workers frequently have little
knowledge of the system until they are injured and it may be difficult to come to terms
with these complexities at a time when they are already under a great deal of stress.
Two participants described how the efforts of the decision makers have resulted in a
greater trust of the WCB. The decision makers are educating the injured worker on the
return to work process and communicating expectations during the process. The
following two quotes illustrate this shift in worker trust:
1. I think there's probably a better understanding and trust within the last six, even
five years. It is not as adversarial as it was perceived to be before. There is more
sharing of information, there is more of a listening to on both parts.
2. I have certainly found a change in how perhaps they trust a little bit more now
because we spend more time with people, like people seem genuinely surprised that
we're taking the time to explain the decisions properly and that we're actually meeting
with them. When I ask people how did everything go for you, they say actually
surprisingly well. You know, way better than it did last time, that kind of thing.
Control of return to work
All the participants reported experiences where the female injured worker takes more
control of her return to work than the male injured worker. The participants reported the
male injured worker is more apt to give control of the return to work decision to the
decision maker. The female injured worker was described to be "more involved" than the

54

male injured worker in the return to work process. The following two quotes illustrate
this:
1. Women are not as easy to give up their power, or not as willing to just sort of let
me make decisions for them, as they seem to be more involved in the process.
2. The women are pretty involved...The men kind of say whatever you're going to
do, sort of thing. It's either they already have their idea made up and they don't care
what I'm doing or we've already come to an easy agreement, they're gone back to
work or they've got something in mind and off they go. The men are throwing it all
up to me, whereas I think the women generally all of them are more directed and have
a lot more of a symbiotic sort of you do this I do that cooperative thing.
A participant explained the injured workers' return to work motivation drives their
degree of control in the return to work process. The participant explained the root of the
return to work motivation for the male injured worker is to regain their social life. In
anticipation of their return to work, the male worker is more willing to give control to the
decision maker. Conversely, the social life of the female injured worker is at home, and
therefore the female is more likely to take control of her return to work and question the
return to work decision:
When they [male injured worker] are at home they're literally not participating at
home. Typically their answers are that they haven't been doing much of anything,
their social life is outside and at work. So their eyeball is getting back to work where
with some of the females their social life is at home. I think the females question it
[return to work decision] for a variety of reasons. They might be more apt to go well
I don't care what your decision is, this is what I'm going to do my job is not to

55

persuade them that my decision is right for them, I'm going to fight a losing battle
on every front. But I think with the women there's lots of work to do at home, so it's
not that she's at home doing nothing. I think her day is still productive and she still
has a social life at home, where I don't think the male does.
Ockander and Timpka (2003) offered the explanation that women are influenced by
other roles, (wife, mother, daughter). The literature (Holmgren & Ivanoff, 2004) supports
that self perception and social patterns created during the period away from the workplace
may be determining factors as to whether or not a woman will return to work.
A participant described the female injured workers' need for control as a "survival
mechanism":
It's just the way women have to be, I mean in the workplace. I think they have more
complicated lives.. .they've got more risk potentially, especially if they have children.
The reality of the world is that half the women that I see are probably divorced or
single and some... you know, they're working because they have to. In lots of cases
they're working because they want to, but I don't know if I see those women
necessarily.. .So it's a survival mechanism. Whereas the guys.. .there's more
opportunities for them, or they've had it easier in some ways you know? They just
kind of wander around from job to job or haven't really had a lot of problems and
haven't given it much thought and, I don't know maybe they just don't think as
deeply about it or are as worried about it.
Ziller (1990) explains how each person constructs a self theory based on the information
that he or she interprets about him or herself and their world in order to predict and control
behavior.

56

Communication
Meeting with the injured worker
All the participants described their experiences meeting the injured worker as
beneficial to establishing trust, providing good customer service and making durable
return to work decisions. The participants explained how a return to work decision made
based on reading the worker's file alone can result in an ineffective return to work
decision. The following quote illustrates this:
I have to say, I will look at a claim and I'll go this guy's going to be a nightmare to
get back to work. Just making presumptions based on what I've seen. Then I meet
with the person and they're.. .it's not what you think. You look at their claims history
and you go wow, this guy's a compo king, he's going to be a problem. And then you
meet him, I'm wrong.
A participant described how actually "seeing" a worker usually provides the decision
maker with a greater understanding of how the injury has impacted their physical and/or
cognitive level of functioning. Meeting with the worker provides objective insight to
making a more informed, and effective return to work decision:
You have a medical opinion that gives you a diagnosis and that's valuable but actually
seeing the person... You're glancing through a claim and there is a lot of documents
and you might see it and you might not. It might stick in your mind or not. But if that
person comes in your doorway, and you see that person standing there, you get a much
better understanding of what you're dealing with.. .For instance, if he's a five foot one

57

inch man, it just gives you a much better idea about maybe the challenge that they will
have with this job that you had in mind.
Similarly, a participant reported using his/her meeting with an injured worker as a tool
for gathering information from the injured worker as well as providing information
through out the decision making process:
You gather more information, they tell you more about themselves, you have a better
understanding of who they are, their family situation, and you can help them work out
those kinks that otherwise might be thrown in, you know, I can't go to work because
I've got daycare. You already know that because you've met them and you've talked
to them about it you find out they've got five kids or whatever. Already you know
that might be a problem on return to work. They've fired the babysitter now because
they're going to be home so you start working on those things early on in the claim.
And so when the return to work comes, it's not a fight, it's not a battle, you've been
talking about it all the way through and they know your reason and rationale for doing
it.
Many of the participants reported how meeting with a worker personalizes the return
to work relationship. One participant described meeting a worker as an opportunity to
"make a connection, they [the worker] see you so you're not just a name. You're not a
nobody and they're not a nobody." The same participant explained how meeting with an
injured worker enhances the worker's return to work experience with the WCB:
Meeting is a chance to get to know them [worker] a little better, maybe break down s
some those concerns they may have or anxiety they may have about having to work
with the Board. Instead of the Board being some nameless, faceless person sitting in

58

an office, they get to meet me. For the most part that seems to go over well and I get a
better rapport and better interaction with them than I would over the phone.
A participant explained how important it is for the injured worker to understand the
return to work decision:
You might not be able to change the decision that you make, but you might deliver it
differently. I have been able to gain from meeting this person as it gives me some
insight as to how they received the information, whether they agree or not, whether
they understand what you're telling them, whether they agree or not.. .You give the
information to them in a way that they will better receive it and therefore better
understand it. Regardless of whether they agree or not have them understand it. Not
only give them expectations about the process, but give them options in situations
where they do not agree with the process.
These findings correspond with Akabas, Gates and Warren (1996) who assert the role
of the decision maker is to serve as a "conduit of organizational policy and procedure" to
the worker (p.27).
Many of the participants reported the worksite as the ultimate venue for meeting with
an injured worker. A participant explained how meetings at the worksite include the
injured worker, the employer, and the decision maker. The focus of the meeting is to
observe the worker's abilities to perform work tasks at the employer's site, consider
accommodations, and discuss return to work options. The communication of all the
stakeholders is focused on the worker's return to work and maintaining their attachment to
the employer:

59

When you're out there [worksite] meeting with them because you're doing your
investigation you're rinding things that you can point out that they could easily do, or
things that aren't going to be an increased risk for them so you're able to share that
information and point out to them. You can also ask them what's easiest for them to
do, what issues are causing them more problems than others, and then kind of
brainstorm while you're there with them and the employer will say - what about

this.

Give them the opportunity to provide input. So I think it's a freer flow of information
in person than over the phone.
These findings correspond with Shrey (1996) who argues the need for employers to
provide return to work opportunities at the worksite that involve workers and other key
stakeholders and refers to the workplace as the "therapeutic environment of choice" (p.
409).
Similarly, a participant reported how a worksite meeting provides the insight
necessary to make a safe and durable return to work decision:
If you meet them at the worksite, and I've done a lot of job visits and site visits in my
day, I can categorically say that it always adds greater clarity to meet them especially
at the worksite. It makes the decision more clear. It doesn't make it a yes or a no
decision. Sometimes it is more clear which way we have to go, and that may be
unfavorable to the worker or maybe favorable but it adds so much more clarity to
understand the real issues.. .a picture is worth a thousand words. You can't see that
on paper or in the office.
Ongoing communication with the worker during the return to work process is
supported by Brines, Salazar, Graham, Pergola, and Connon (1999) who assert the

60

frequency of contact by the decision maker is found to be related to the worker's
satisfaction with how his/her claim is managed. These researchers do not define the
nature or the setting of the contact.
Delivering the return to work decision
While the experiences of the participants varied, the decision makers explain how the
gender of the injured worker influences the methods they [decision makers] employ to
communicate their return to work decisions. A participant described how the male injured
worker is less interested than the female injured worker in a decision making rationale
based on law and policy:
The men do not want to hear about law and policy. They absolutely do not. In that
initial conversation that I've had with them, I've kind of told them what policy I'm
looking for that I am restricted to the policies that we have. Neither of them I would
get specific as to delving into what type of policies that apply and giving them quotes
or anything like that.. .Where the females I find are a little bit more attuned to the
process than the men are.
Another participant explained how he/she spends more time with a female injured
worker explaining his/her return to work decision. This same participant reported the
female injured worker has a more difficult time moving forward from the return to work
decision than the male injured worker:
A woman I think tends to be, if she's got an issue that is bothering, or she's got an idea
that something is the way she sees it to be more, they're much more involved in it and
not willing to see it any other way than the way they see it. Whereas I find sometimes

61

with a man, they're more receptive to understanding something and then putting it
aside. Whereas a woman I think sometimes tends to hang on to it a little bit more.
This corresponds with Hampton and Crystal (1999) investigations of gender
differences in acceptance of disability as a step toward return to work. Their findings
support that females with a disability have a lower level of acceptance of their own
disability than males with a disability.
The experiences of the participants varied with their comfort level rendering a
negative decision to a male injured worker compared to a female injured worker. One
participant described how he/she makes more effort to communicate a decision to a
female injured worker as, "I might make more of an effort to try and explain it all over
again, offer to meet again", as opposed to his/her efforts of delivering the return to work
decision to a male injured worker, "I want to explain it, but I don't want to be bullied. So
I get firmer."
A male participant described how engaging at an emotional level with a male worker
"does not seem like the right thing to do". He explains how he uses reason to help the
male worker understand the return to work decision compared to his willingness to go
through the "emotional part" of the return to work decision with the female worker:
I have a hard, almost impossible time, of talking about intimate things with a claimant
who is a man... I don't talk about my intimate things, but their intimate things,
especially if it takes eye contact.. .like close heart to heart kind of discussions with a
man. And often that can be tied up with a decision on return to work. I have no
trouble doing that with the women and I probably go there much more readily with
the women. I would probably not describe or explain decisions using reasons as
62

much as I would with the women as much as I would try to talk about it. Not simplify
it, but I would certainly much more go through the emotional part of it.
A participant reported his/her experiences dealing with an angry female worker
compared to an angry male worker:
What I've learned is I try to step back and just let them [male injured worker] vent
and I ask them, can I say something now? And normally that's enough for them to
vent and, if not the call just ends. The women usually cry. I don't hang up on
them.. .1 just say, you know unfortunately there's nothing I can do for you.. .1 don't
like it. I'm not in your shoes but it's frustrating.. .1 review the process. I give them
options.
An analysis of the above, is contrary to the findings of Ahlgren and Hammerstrom
(2000) assert the behavior of an injured male worker to be more in line with structures in
the compensation system, "the most important factor for return to work after a work
related injury, even after controlling for education and sick leave, is to be a man" (p. 94).
Case Management in WCB
Team
All the participants reported varying experiences with case management and its impact
on mitigating gender bias in return to work decisions. However, all the participants
agreed the multidisciplinary nature of the team offers differing perspectives from both
genders which influence the return to work decision. Two participants described how

63

working in a team environment compared to working in isolation mitigates the potential
for gender bias in their decision making. The following two quotes illustrate this:
1. When you have a case management team, you've got lots of personalities in the
room and it's a free flow sort of discussion often. If you've got male and female
decision makers then you might have some varying discussion about where that
person's coming from or, you know, those sorts of things can come into play.
2. You don't have one person making a singular decision with all of those biases, or
perceived notions, where instead if you have two or three people who play devil's
advocate or whatever but bring other influences into it that kind of steers you the right
way...It's for understanding that those issues are there, but how can we work with
them or around them to still get to where we want to go the best way we know how.

Introduction of the psychological-social issues
The participants were asked about their experiences with the introduction of
psychological-social issues of the injured worker as a result of case management. The
participants described how an awareness of the worker's non compensable issues is
necessary to make an effective return to work decision. Two participants described how
they consider the psychological-social issues of the injured worker as they pertain to the
worker's recovery and/or delay in return to work. The following two quotes illustrate their
experiences, both with reference to single parents and the issue of childcare:
1. For instance, this worker is a single mom. This issue is can she do modified duties.
They've changed her shift to an afternoon shift where she typically doesn't have
daycare issues, so that's when you bring into focus she's a single mom, therefore these

64

modified duties may not be appropriate because it's going to cause her some problems
at home with her kids.
2. If it's a single mother let's say, or a single father, it doesn't matter, and they're off
on claim. That's important to know, if the kids are at home because there's a whole
bunch of issues that come and that we can't prove, but can delay a claim and impact
the recovery and everything else.
Another participant described how the level of return to work services provided to the
injured worker requires the decision maker to have more than an awareness of the
compensable issues; they must understand the worker's psychological-social situation:
The whole intent of talking about the client and saying, this 36 year old single mom,
she's got three children under the age of five, who is a gas attendant, something like
that puts in my mind somebody who's got a difficult road and I like to think that if
anything what that does is help me to say this worker is going to need some help to get
back to work fairly soon because she's got a big family to support and you don't want
anyone to walk away from that thinking that well she's going to enjoy being on claim
because now she can be home with the kids.
Dees and Anderson (1996) support assessment as a best practice in the disability case
management process including identifying the worker's physical and functional status, as
well as the resources and/or service needs for their individual needs. An appropriate
assessment of the worker's needs leads to appropriate medical treatment, successful
recovery, and reintegration into the workforce (DiBenedetto & Hall, 1995).
One participant described how the psychosocial issues of an injured female worker
more quickly become return to work "red flags" than for an injured male worker:

65

I think there is a difference in that kind of situation that's different between, very
subtle and not always the case, I think if a woman worker who's hurt starts to present
with psychological issues in the early stages, than a man in the same situation. I think
there's collective fear around the table in the woman's case, more quickly that this is
going to become an all encompassing thing. So whatever strategy ensues from that can
be different each time, but I thing there's maybe a bias that a woman's going to let it
overwhelm her more than a man will. If a man starts on that stuff it's like, well let's
just forget about it and he'll probably forget about it...It won't become an issue until
later on.
Similarly, another participant explained how the female injured worker is more likely
than the injured male worker to introduce the non-compensable issues, which are often
distractions that prolong the return to work decision:
They are talking to you about their kids, they're talking to you about how they can't
get around, they can't go to the bathroom, their explaining how their wife has to do
this, how their kids are not having to do this. They're explaining things that aren't
really relevant to the issue on the claim and so you know right away what you need to
wade through, it's going to take some time to wade through and find the facts.
Typically females have more of that in my experience, than the males do. The
decision is the same it's just that the investigation will prolong it.
Dyck (2000) argues the strong indicators for immediate case management
involvement include an expected long recovery, potential for permanent disability, lost
workdays exceeding disability duration guidelines, and workers with poor employer

66

relations. Dees and Anderson (1996) suggest the 'indicators' also include psychosocial,
financial, health and litigation factors.
Severity of Injury
Two male participants reported that the gender of a catastrophically injured worker
impacts their return to work decision. These decision makers reported how the severity of
an injury has a greater impact on potential gender bias when the worker is female. Both
participants expressed some hesitation and doubt in a positive return to work outcome for
the catastrophically injured female worker. The following two quotes illustrate the
participants' experiences making return to work decisions on claims where the female
worker was severely injured:
1. I feel you know that it might be worse for the women just because it attacks on
their beauty and their physical appearance and indeed stand out more, you know,
whereas with a man, well, there's lots of guys wandering around with fingers missing
and arms missing and people just sort of accept that because it's a part of work.
Whereas for a woman we go holy what the heck happened to you? Because I'm a
man you're thinking I wonder what it's like not being able to have an arm. I wonder if
makes it harder for you to meet men, I wonder if that makes your life really hard.
How are you going to go to work?
2. I have long noted that when a woman has a horrific injury, like an amputation, it
troubles me terribly. It bothers me if a man does, especially a young man, but if a
woman has a disfiguring injury it's all I can do to read that somehow, it just bothers
me terribly. I immediately assume they're going to need psychological care or
counseling or some help.. .this is at a visceral emotional level. It's not that I assume

67

that it's going to be worse for them than it would be for a man.. .Whether or

not they

would get a different decision, I don't know. But they certainly would leave me to
look in different places for my decision strategies right away.
Hanna and Rogovsky (1991) argue that socio-cultural stereotypes result in women
with disabilities being unfairly stigmatized. For example, the word 'woman' was
associated with concepts of beauty, whereas the term 'disabled woman' was associated
with adjectives such as 'ugly' or 'unpleasant' (p.57). These researchers found that more
negative stereotypes and personal blame are attributed to female images of disability than
to male images of disability

Law and Policy
Neutrality
The views of the participants varied when asked whether they considered the law and
policy to be gender neutral. Two participants viewed the law and policy as gender neutral
with contrary views on the impact of its neutrality on potential gender bias in making
return to work decisions. One of these participants reported how gender bias is introduced
by the decision maker in his/her interpretation of law and policy:
I think it's neutral and I think that it becomes discretionary depending on who is
managing that claim and working with those individual workers.. .Thinking back to a
male who had the flu while going to a program, I allowed him days off just as much as
I would put in some discretion for a female going for a pregnancy test or an
ultrasound.. .It's our own interpretation of those, where those grey areas come in what
discretionary stuff can we do, and that's where your personal stuff comes into it.

68

Another decision maker viewed the neutrality of the law and policy allowed for no
gender bias on the part of the decision maker. This participant opined the Act is "not
suppose to be relative to gender.. .it is suppose to be arising out of and in the course of
work". This participant explained the decision maker is obligated to consider the injured
worker as a 'worker', void of gender, in their interpretation of the law and policy.
A participant explained how male and female workers have the same return to work
issues, and therefore he/she views the application of the law and policy as "applied
equally to both":
You have the same issues whether it's [worker] male or female. Your decision
making process should be the same and the outcome should be the same... It comes
down to the issue, what's the issue? It doesn't matter if it's [worker] male or female.
Many of the participants viewed a marginal shift in law and policy, specific to
addressing the needs of the female injured worker. One participant described this shift
using the example of occupational injuries not associated with a single event, which
account for the majority of women's claims:
The Act in the 1960's said that you had to have an accident before it could be
accepted, there's no injuries over time were accepted at all. It was assumed that the
kind of work that we [WCB] were covering was the kind of work where you, if you
got hurt it was because of an accident.. .It wasn't until now that injuries over time,
which women tend to have a lot of injuries over time, with the kind of work that
women often do in hospitals they're not necessarily an accident. So there's an
understanding as we've gone along that we need to include more real work injuries
that are unsafe.

69

The participants' accounts of how the law and policy fails to address those injuries
which occur over time, more often in female dominant industries, correspond with the
literature. Ostlin (2000) and Hall (1990) assert working conditions and occupational
health problems of women are less likely to be addressed by employers, unions,
researchers and policy makers. Chung, Cole and Clark (1998) suggest the relatively
statistically lower number of claims amount for women is in part due to the legislation and
the reporting process of an injury. For example, occupational injuries and illnesses,
particularly those which are not associated with a single event (activity related soft tissue
injuries) and that account for the majority of women's claims, may influence both the
reporting of injuries as well as the adjudication process.
The participants who reported a gradual shift also opined the law and policy did not
sufficiently address the dual role of home and work for women. A participant explained
how the 'relocation' policy is an example of the shortcoming of law and policy:
Many women are working, they have a dual role, having children and working. They
are often the primary breadwinner in the family. So when we have a return to work, I
don't think we have any real concession when we talk about relocating how it's more
difficult for a woman to relocate and I don't think we've really moved there to where
we have any kind of concept of the difficulty.. .we have the same rules and those rules
were made because man was the breadwinner and he could relocate and we didn't
really look at well what does his wife do? And if the wife is going to relocate then
she's really at a disadvantage in some ways. So that's why I say we are paternalistic,
although we're moving towards considering those things, but we're not there.

70

Similarly, another participant explained how the law and policy is not in keeping with
the changing realities for an injured female:
I think it's trying.. .it's gradually changing but when you think about the sort of
pressures on women who might have elderly parents as well as children to look after,
as well as going to work. You don't very often see any way to help them with that.
So, if they're injured at work, it's not just one job they can't do. They can't do the
other jobs either.
Value conflict
All the participants reported experiences where their personal values conflict with
their professional obligation. The participants reported that the conflict surfaces when the
decision maker must separate the subjective nature of his/her relationship with the injured
worker from the application of law and policy in the return to work decision.
The participants described how value conflicts for the decision maker are an inherent
risk of developing a rapport with an injured worker, despite their gender. One
participant's experience illustrates the decision maker's conflict between the subjective
nature of his/her relationship with the injured worker, and the objective evidence on the
worker's claim:
Sometimes I think it's easier because we have a chance to build a rapport, which
means we can work together on the plan rather than in isolation. But sometimes, you
know, you get caught up in things and you can get pulled off into some tangent and
you wouldn't normally be pulled off on because you've met with them and got
caught up in what's going on with them potentially and maybe lose some of your
objectivity. Personal things and you know, feeling potentially sorry for them as

71

opposed to just trying to be objective and going through the process. At the end of
the day decisions are made based on evidence and regardless of your personal
interaction with somebody, that evidence still is what evidence is. I think sometimes
meeting people, it makes me glad that we do have law and policy we rely on to
make our decisions because sometimes we can be emotionally drawn on some level
by personal interaction with a person.
This finding is supported by Keating and Smith (2000) who argue that our individual
values influence how we respond to ethical issues and decisions we make. There are
times when there is a struggle between personal beliefs and professional responsibilities.
Subsequently, value conflicts surface in situations where our actions conflict with our
beliefs. Ethical dilemmas arise when the best course of action is unclear, when strong
moral reasons support each position, and when we must choose between the "most right or
the least wrong" (p. 15).
A participant described how using the law and policy helps him/her separate how
he/she feels about an injured worker from the return to work decision: "I have rules to
follow and so in this case I'll just fall back on them, and that way I maybe don't feel quite
as bad about it because I can sort of depersonalize the whole thing."
Similarly, a participant described how the law and policy rescues him/her from
"getting caught up in the personality and the issues" of the injured worker, and attributes
his/her success as a decision maker, "law and policy, that's my savior because if it was an
emotional thing I'm not sure I could do the job well because you are influenced if you let
yourself be, by people with their emotions."

72

A participant described the law and policy as a means of protection from potential
gender bias, "even though you thought of the male female thing, the law and policy is
what keeps you on the straight and narrow because that's where I have to end up."
One participant reported how decision makers "hide behind law and policy" as a
means of avoiding making the extra efforts and/or potential risks of not complying with
law and policy:
I think sometimes it's easier to do that [hide behind law and policy]. Sometimes it's
easier to look at it in a more black and white way and say, well I'd love to be able to
do that for you, but this policy here tells me that I can't. A couple of times I've been
in situations where I really put a lot of energy into saying this person does not exactly
fit this policy but we ought to find a way to help them.
The above noted finding corresponds with Beach and Connolly (2005) who assert that
a decision that violates the organization's beliefs and values is a threat. In light of this,
decisions are made to protect the core values rather than making a positive move to
produce some good or benefit for another (beneficence).

73

Chapter 5
SUMMARY, CONCLUSION, AND RECOMMENDATIONS
Summary
This qualitative research uses a phenomenological approach to understanding the
phenomena of gender and examines the views, perspectives, and experiences of the decision
makers in the compensation system. The purpose of this research was to gain a better
understanding of how the gender of an injured worker influences the decision makers and their
return to work decisions. Semi-structured interviews were employed to capture the multiple
perspectives of eight decision makers as well as any tensions or contradictions in their
individual experiences.
The literature explores gender within the framework of return to work from a health, social,
psychological, and vocational perspective. With respect to the workers' compensation system,
the research suggests gender differences are inherent to a system perceived by injured workers
to be "uncaring, unfair, and adversarial" (Dembe, 2001, p. 408). Chung, Donald and Clark
(1998) assert the recognition of gender biases in the workplace, among health professionals
and among workers' compensation staff, could result in an increased rate of accepted claims
and a decrease in delayed reporting for women. Yet a review of the literature supports that
there is a gap in the information related to the influence of an injured worker's gender on
return to work decisions made by the decision makers within the workers' compensation
system.
The study is presented in a written format summarizing the findings from my data analysis
captured in the five major themes emerging from the data: understanding the decision maker,
the injured worker, communication, case management, and law and policy. There are several

74

sub-themes subsumed within each of the major or key ideas. Entwined in the major themes
and sub-themes is the central theme: Regardless of their decision making role, all the decision
makers recognize the value of work and its human and financial benefits, despite the gender of
the injured worker.
The first major theme, understanding the decision maker, includes the sub-themes of
training, decision making approach, stereotyping the injured worker, framing decisions, gender
of the decision maker, and self awareness. All the participants described their approach to
making return to work decisions as "discretionary" in nature, with some imposed constraints of
law and policy. The participants are aligned with a specific industry and/or an employer of
BC. Being an industry aligned decision maker includes decision making responsibility on all
claims resulting in illness and/or injury at the workplace. As the decision makers' exposure to
the workers and their knowledge of the industry increased, there was a reported shift in the
participants' stereotypes of the male injured worker. The low participation rate of women in
industry may be a contributing factor to no reported experiences with stereotyping of female
workers. This is supported by Hanna and Rogovsky (1991) who assert the less frequently
women with disabilities participate in work, the more cultural stereotypes persist about their
roles in society. The impact of stereotypes against women can lead to social and psychological
barriers in their transition to employment.
In light of the above, all the participants reported they did not allow their familiarity with
the workers and the employers in their aligned industry inference their return to work decision.
The participants' experiences reported how the individual circumstances of both the female and
male injured worker are the primary factor in making return to work decisions. This is

75

supported by Hunt, Barth, and Leahy (1996) who argue that decision makers are not to begin
fact finding with any presumption against or for the injured worker.
The participants reported a varied sense of self awareness of gender and its impact on
making return to work decisions. One participant explained how a female decision maker is
more effective than a male decision maker with making return to work decisions for a
predominantly male industry. Similarly, two of the participants reported that when gender of
the decision maker was the same as the gender of the injured worker, the return to work
decision was compromised. The male decision maker experienced giving the male injured
worker "a bit of a break"; whereas, the female decision maker was described as being "harder
on women [injured female workers]". Three male participants reported a heightened self
awareness of potential gender bias working with the female injured worker. These findings
correspond with Chung et al. (1998) who assert the recognition of gender biases among
workers' compensation staff are likely to result in less frequent delayed reporting and an
increase in accepted claims for women.
The second major theme, the injured worker, includes sub-themes of trust, and control. All
the decision makers agreed there is a lack of trust by the injured worker, despite the gender, of
the WCB. The participants reported reasons for worker distrust as length of time on claim and
a poor knowledge of the return to work process. This finding corresponds with Dembe (2001)
who asserts injured workers frequently have little knowledge of the system until they are
injured and it may be difficult to come to terms with these complexities at a time when they are
already under a great deal of stress.
All the participants reported experiences where the female injured worker takes greater
control of her return to work decision compared to the male injured worker. The female

76

injured worker is described by two participants as more "involved" in the return to work
process. One participant reported that because the return to work motivation for males and
females differ, so does their need for control of the return to work decision. This same
participant described it is easier for the male injured worker to give control to the decision
maker in anticipation to get back to work and regain their social life, whereas, the female
injured worker questions the return to work decision to maintain their social life at home. This
finding corresponds with Ockander and Timpka (2003) who assert that women are influenced
by other roles (wife, mother, daughter), and that their self perceptions and social patterns
created during the period away from the workplace may be determining factors as to whether
or not a woman will return to work. Similarly,a Holmgren and Ivanoff (2004) study suggests
women go from losing control of everyday life to mastering life as a whole and finding, or not
finding, a way to return to work.
Only the female decision makers reported experiences of feeling stereotyped, in all cases,
by the male injured worker. These participants explained how being a "woman" in a position
of authority is a reality the injured male worker has difficulty overcoming. One participant
described feeling stereotyped by the male worker as a "distraction", having a negative impact
on the return to work decision.
The third major theme, communication, includes the sub-themes of meeting with the
worker, meeting at the worksite, and rendering the return to work decision. All the participants
identified meeting with the injured worker as a best practice in making return to work
decisions. The primary benefits of meeting with the injured worker was the reported
opportunity to personalize the return to work process, and at the same time, gather information
from the worker to make an effective return to work decision. One participant explained how

77

meeting the injured worker is an opportunity to establish rapport and decrease the worker's
potential anxiety with the system citing: Meeting is a chance to get to know them [worker] a
little better, maybe break down some concerns they may have or anxiety they may have about
having to work with the Board, instead of the Board being some nameless, faceless person
sitting in an office.
The worksite setting was reported by the participants as an opportunity to involve the
worker and the employer in brainstorming a collaborative return to work outcome. One
participant explained how "you might not be able to change the decision that you make, but
you might deliver it differently." The participants' experienced greater success with how the
worker reacted to the return to work decision, despite its nature, once rapport had been
established and the worker felt they were part of the return to work process. Brines, Salazar,
Graham, Pergola, and Connor (1999) assert the frequency of contact by the decision maker
with the injured worker is related to the worker's satisfaction with how their claim is managed.
These researchers do not define the nature of the contact, and/or the setting of the contact.
The fourth theme, case management, includes the sub-themes of team demographics,
severity of injury, and the introduction of psychological-social issues. The decision makers
reported varied experiences with case management and whether its implementation fosters
and/or mitigates gender bias in making return to work decisions. One participant described
how the mixture of male and female decision makers on the team provides a balance of
perspectives which mitigate gender bias in the return to work decision. Another participant
reported how the team environment deters the potential for gender bias as compared to the
decision maker working in isolation and making return to work decisions independently.

78

The introduction of the psychological-social issues of the injured worker was described as
"insightful information" only as it pertains to the injured worker's recovery and/or delay in
their return to work. The participants' reported their experiences with the psychological-social
issues as more frequent with the injured female worker compared to the injured male worker.
The participants described the non compensable issues raised by the female injured worker as
"red flags" and distractions prolonging the return to work decision.
Only one participant reported how his/her awareness of the worker's non-compensable
issues influenced the level of return to work services provided to the worker. This finding
corresponds with Dees and Anderson (1996) support of the disability case management
process which includes identifying the worker's physical and functional status, as well as the
resources and/or services for their individual needs. Moreover, DiBenedetto and Hall (1995)
maintain an appropriate assessment of the worker's needs leads to appropriate medial
treatment, successful recovery, and reintegration into the workforce.
The fifth and final theme, law and policy, included the sub-themes of neutrality and value
conflict. Many of the participants viewed the law and policy as gender neutral in nature, with
varying experiences on whether the gender specific needs of the injured worker are being met.
One participant explained how the decision maker's interpretation of law and policy introduces
gender bias into return to work decisions. Conversely, a participant reported how the
neutrality of the law and policy allowed for no gender bias in its interpretation. A participant
reported male and female workers have the same return to work issues, and therefore he/she
viewed the law and policy as "applied equally to both."
The participants' reported an observed shift in the law and policy in an attempt to address
the dual realities of home and work for female injured workers. Yet these same decision

79

makers reported experiences with the relocation of workers and injuries which occur over time,
as examples where the law and policy fail to address the rising needs of the female worker.
This finding corresponds with Ostlin (2000) and Hall (1990) who assert working conditions
and occupational health problems of women are less likely to be addressed by employers,
unions, researchers and policy makers.
All the participants reported experiences where their personal values conflicted with their
professional obligation. The decision makers experienced ethical dilemmas when in situations
where their implementation of law and policy compromised their established relationship with
the injured worker. Many of the participants described the law and policy helped them
"depersonalize" the return to work decision, when they felt "emotionally drawn" to the injured
worker. A participant viewed "hiding behind the policy" as self justification precluding the
decision maker from making the necessary efforts to find a means of helping the injured
worker. These findings correspond with Beach and Connolly (2005) who assert that a decision
that violates the organization's beliefs and values is a considered a threat; therefore, decisions
are made to protect the core values of the organization rather than making a positive move to
produce some good or benefit for another (beneficence).
Conclusion
The data gathered from this study provide an understanding of the experiences of the
decision makers in the workers' compensation system in making return to work decisions, and
how the gender of an injured worker impacts these decisions. The five themes that emerged
from the study are: understanding the decision maker, the injured worker, communication, case
management, and law and policy.

80

My view is that there is a disparity in the decision makers' formal role and their perceived
role in making return to work decisions. The formal role of the decision maker is guided by
legislation and policy, and is exercised only at the end of the decision making process when a
formal written rationale for the decision is required. In other words, the return to work
decision is made first based on the decision maker's discretion and then rationalized with
reference to law and policy. The reported discretionary nature of return to work decision
making suggests there is a potential for the decision maker to introduce their gender specific
stereotypes and assumptions in making return to work decisions. In my opinion, the restrictive
nature of the law and policy obliges the decision maker to introduce their discretion.
Therefore, effective return to work decisions are largely reliant on the skills and abilities of the
decision maker to implement services individualized to the differing needs of the male and
female injured worker.
The WCB implemented industry alignment and case management as best practises in
making return to work decisions. In my view, these combined processes provide for return to
work decisions which focus on the worker and the worksite. Being aligned to an industry
increases the decision maker's knowledge of the industry job demands and the work culture,
and strengthens the relationship with the employers within the industry. This familiarity with
the worksite and the employer results in a return to work decision where the individual
worksite related circumstances of the injured workers are considered. Case management
focuses on injured workers by introducing the worker's psychological-social issues as they
relate to return to work. The case management team meeting is a venue for an interdisciplinary team to consider the injured worker's relationship with the employer, his/her fear
of change and re-injury, as well as the individual worker's concerns about his/her return to

81

work . In my view, industry alignment and case management implemented together result in
more informed and collaborative return to work decisions. Introducing workers and the
worksites as part of the return to work decision influences the level of services required to
meet the individual needs of injured workers, for both men and women.
All the decision makers reported there is a lack of trust by the injured worker of the WCB,
despite the gender of the injured worker. In my view the distrust of both female and male
injured workers is rooted in the WCB's failure to recognize that early contact and effective
communication are necessary return to work interventions. First contact with injured worker is
often delayed and used primarily to gather evidence in order to adjudicate whether the claim is
accepted or denied. In my opinion, there is a missed opportunity in first contact with injured
workers to promote worker communication with the accident employers and their attending
physicians, encourage safe recovery at the worksite, and set expectations on the return to work
decision making process. Meeting with the injured workers helps to establish rapport by
personalizing the return to work process, and allows for a more positive return to work
experience for injured workers, despite their gender. In my view, an in person meeting with
workers is the most effective means of communication with the greatest impact on building
worker trust with the decision maker and the WCB.
The female decision makers experienced feeling stereotyped by the male injured workers.
Being on the receiving end of the gender stereotype introduces the potential for a negative
impact on return to work decisions for male injured workers. Also, the female decision makers
are more likely to be influenced by their other roles (wife, mother) resulting in the potential for
varying degrees of empathy for injured female workers. Depending upon the personal
circumstances and experiences of the female decision makers the return to work decision is at

82

risk of being compromised. Interestingly, the female decision makers' had a low self
awareness of how the gender of injured workers impacts on their return to work decision,
whereas, the male participants had a heightened awareness of potential gender bias working
with female injured workers.
Recommendations and Implications for Practice
This research is preliminary and therefore provides one description of the experiences of
the decision makers in the compensation system. The study recognizes the stories of eight
decision makers in one service delivery location and provides descriptions of their experiences
with how the gender of an injured worker impacts their return to work decisions. It is my belief
that further research and investigations to extend findings has the potential to impact the
workers' compensation system in a positive manner. My recommendations for future research
includes investigating how the gender of the decision maker influences return to work decision
making; measuring the nature of return to work interventions and the return to work outcomes
for male compared to female injured workers; and, measuring male and female worker
satisfaction and return to work outcomes for those claims where the decision maker had a
meeting with the injured worker compared to those claims where no meeting occurred.
Further recommendations and implications for practice include:
1.

Self assessment tool designed to assist decision makers to recognize their social and
cultural biases. The implementation for practice requires that appropriate tools are
provided to decision makers to deal with situations where their biases compromise
their decision making or potentially impact their relationship with injured workers.

2.

That the WCB continues to align decision makers to industry specific employers,
and continues with the implementation of industry alignment as a best practice in

83

making effective return to work decisions. The implication for practise is to collect
more data on the experiences of the decision makers aligned with female dominant
industries for example, health care.
3.

That the WCB continues to recognize and implement case management as a best
practice in making effective return to work decisions. The implication for practise
is that the decision makers support the belief that medical intervention is not the
only answer to a return to work. This will result in a more holistic approach to
making return to work decisions by decision makers despite the gender of the
injured workers.

4.

That the WCB adopts a process where contact is made with workers at the point of
claims registration, pending an accept/deny decision in order to promote worker
communication with the accident employer and their attending physician, encourage
safe recovery at the worksite, and set expectations on the return to work decision
making process. The implications are resource based, in that there must be a correct
number of staff in place to meet the volumes of claims and/or customer demand.

5.

That meeting with an injured worker be a mandatory service expectation and return
to work intervention. A timeframe from the date of injury to a face to face meeting
should be expected and enforced by managers as a key performance indicator for the
decision maker.
Limitations of the Study

Every attempt to minimize chance of error has been made but the researcher also
acknowledges that "it is not possible to achieve perfect reliability if we are to produce
meaningful studies of the real world" (Taylor and Bogdan, 1998, p. 9). There are inherent

84

influences that are beyond the control of the research project. These extraneous variables also
contribute to the 'richness' of qualitative data. This richness is critical to gain insight into an
issue, in this case the experiences of decision makers and the influence of gender in making
return to work decisions. Enlisting

a relatively

small number

of participants,

eight

participants, was purposefully employed due to the exploratory nature of the research. The
sample invites multiple perspectives, and differing decision maker roles, further dissected into
a female and male participant within these roles to achieve the stated research purpose. Some
limitations to the sample may exist, as the participants were chosen in part by geography, as
decision makers specific to the WCB in Prince George, with varied educational backgrounds
and work histories.
Interviewer bias and interview questions may also be considered a limitation to the study.
The researcher is a decision maker within the Prince George WCB service delivery location.
The researcher has experienced two decision making roles within the WCB, vocational
rehabilitation consultant and client service manager. Interview bias may conceivably been
introduced if unknowingly the interviewer employed less than ideal techniques or exhibited
certain behaviours or characteristics that could have had an effect on participant response to
questions (Morse & Field, 1995). Every effort was made by the researcher to minimize
interviewer influence on the participants' responses by delivering a professional and consistent
approach to interview questions.
The interview questions were formulated prior to the interview, and guided by the
responses of the participants during the semi-structured interview. The pre-determined
questions maintained thematic underpinnings of the literature. In light of this, the questions

85

were open-ended and the participants were encouraged throughout the interview to expand on
their thoughts.
The influence in the interview questions is unavoidable in order to achieve the thematic
orientation of phenomenology. Due to the sample size, eight participants, the results of the
study cannot be generalized to all decision makers in the WCB; however, this does not
minimize the value of the research findings to identifying issues of value to the decision
makers and the WCB, and worthy of future research.
Future Research
While this research is preliminary, the study will facilitate research on the phenomena of
gender, specifically the gender of injured workers, and its impact on the return to work
decision makers within a workers' compensation system. The study will also assist the
decision makers in identifying their own gender biases. My hope is that this self realization
will impact future decision making and thus enhance disability management practices in the
return to work of an injured worker, despite his/her gender. The study may motivate the WCB
to further research on whether a gender-neutral approach in policy and legislation contributes
to less attention and fewer resources being directed to the unique needs of men and women
during the return to work process.
Personal Reflections of the Study
The study made me realize the WCB has made very few strides, if any, to acknowledge the
differing needs of the male and female injured worker in return to work. This includes
providing education and support to the decision maker to increase awareness of these needs
and/or mitigate potential gender bias in making return to work decisions.

86

Completing this research was a gratifying and enlightening experience. The stories of the
participants illuminated the realities of the decision maker in their quest to achieve the strategic
initiatives of the WCB, making a difference one human being at a time, and changing societal
attitudes. I realized the organizations' only hope to truly achieve this vision lies with the
decision makers and their skills and efforts necessary to overcome the barriers to return to
work long rooted within the 'system'.

87

Appendix A
Consent to Access Site Form

I, Maria Stancati-Ens, request the use of an office at the Prince George service
delivery location of the Workers' Compensation Board. It is my intent to conduct eight
interviews for a research study which forms the thesis component of the Masters of
Disability Management at the University of Northern British Columbia. The purpose of
my research is to understand how the gender of an injured worker influences the decision
maker's experiences in facilitating and implementing return to work decisions.

The interviews will be individual and confidential. Each interview will be in person
consisting of an audio-taped dialogue lasting approximately 60 to 90 minutes. As the sole
researcher of the study I will provide the audio taping equipment. The interviews will not
interrupt the regular working hours or practices of the Workers' Compensation Board.
They will be scheduled to take place from February 18, 2008 through to February 29,
2008.
There are no known risks to the Workers' Compensation Board if office space is
provided. As the sole researcher of the study I cannot guarantee that the Workers'
Compensation Board will benefit from providing interview space for this research. In light
of this, my study may lead to a greater knowledge of how the gender of an injured worker
may impact the return to work decisions made by the decision makers. Consequently,
adding value to the professional development of your staff.
The choice to provide consent for interview space for my study is completely
voluntary. The Workers' Compensation Board of BC is free to withdraw consent for
interview space at anytime without prejudice. If you have further questions, please
contact me at:
Maria Stancati-Ens
c/o Dr. Henry Harder, University of Northern British Columbia
3333 University Way
Prince George, BC, V2N 4Z9
(250) 612-4941
Complaints may be directed to the office of the Vice President of Research
at (250) 960-5820.

88

The signatures of the Workers' Compensation Board Client Services Manager
indicates he/she has read this Consent to Access Site Form and agrees to provide
interview space for this study at the Prince George service delivery location.

Signature of Client Service Manager

Date

Printed Name of Client Service Manager

Signature of Researcher

Date

Printed Name of Researcher

Signature of Witness

Date

Printed Name of Witness

89

Appendix B
Agreement of Participation Forms
Information Sheet

Researcher:
Maria Stancati-Ens
c/o Dr. Henry Harder
3333 University Way
Prince George, BC, V2N 4Z9
Telephone: (250) 960-5363
E-mail: stancatm@unbc.ca
Supervisor:
Dr. Henry Harder
Chair of the Health Science and Psychology Programs
Title of project: Influence of an injured worker's gender on return to work
decisions: Experiences of decision makers within the Workers' Compensation Board
Type of project: Thesis
Research purpose:
The purpose of the research study is to understand how the gender of an
injured worker influences the decision maker's experience in facilitating and
implementing return to work decisions.
Potential benefits and risks:
There are no known risks associated with participation in this study. I cannot
and do not guarantee benefits from the study.
Participant selection:
The participants for the study are selected based on their decision making
authority to administrate the Workers' Compensation Act specific to return to
work decisions.
Participant request:
The participant will be asked to participate in an individual, in-person 60 to 90
minute audio taped interview. The participant will not be required to answer
specific questions they do not wish to address. The interview process can be
discontinued at any time at their request.

90

Access to responses:
The responses will be available to the researcher, the research supervisory
committee, and the transcriber of the audio taped interview to written form. The
transcriber will enter into a confidentiality agreement.
Voluntary participation:
The participation of the all the participants is voluntary. The interview process
can be discontinued at any time, at the request of the participant. If the participant
withdraws, corresponding information will also be withdrawn from the study.
Renumeration:
There is no financial compensation for participating in the study.
Anonymity:
The researcher will modify the transcripts to remove all identifying
information such as name, position, job duties. The information will be coded to
insure identifying information is not revealed.
Confidentiality:
The transcriber of the audio taped interview will enter into a confidentiality
agreement.
With only 8 participants located on the same site, I will make every effort to
insure complete confidentiality.
Storage:
The original transcripts and audio tapes will be stored in a locked storage at
UNBC for one year after successful completion of the thesis. Thereafter, the
material will be destroyed. The transcripts will be shredded and the tapes will be
physically destroyed.
Complaints:
Complaints maybe directed to the office of the Vice President of Research at
(250) 960-5820.
If you have further questions, please contact me, Maria Stancati-Ens, at (250)
960-5363.
All participants in the study will receive a copy of his or her signed consent
form.

91

Appendix C
Agreement of Participation Forms
Informed Consent
Do you understand that you have been asked to be in a research study?

Yes

No

Have you read and received a copy of the attached information sheet?

Yes

No

Do you understand that the research interviews will be recorded?

Yes

No

Do you understand the benefits and risks involved in participating in this study?
_Yes
_No
Have you had an opportunity to ask questions and discuss this study?
Yes
No
Do you understand that you are free to refuse to participate or to
withdraw from the study at any time without prejudice?

Yes

No

Has the issue of confidentiality been explained to you?

Yes

No

Do you understand who will have access to the information you provide?
Yes
No
This study was explained to me by:
Print Name
I agree to take part in this study:
Date:
Signature of Research Participant

Printed Name of Research Participant
Date:
Signature of Witness

Printed Name of Witness
I believe that the person signing this form understand what is involved in the study and
voluntarily agrees to participate.
Date:
Signature of Investigator
The Information Sheet is attached to the Consent Form and a copy is provided
for the Research Participant.

92

Appendix D
Interview Guide
1. Introduction
•

Tell me about your current position with the WCB?

•

What type of training did you receive for your current position? Can you describe
the nature of your training?

•

Have you held other positions with the WCB? If yes, what were they?

•

How long have you worked for the WCB? How long have you worked in your
current position?

2. How do you feel your current decision maker role fits in the return to work process?
•

How do you feel your perspective of your role in return to work fits with the
organizations directive?

•

Where would you consider your decision making role fits (front end or back end)
of the claim? Why?

•

How would you describe your decision making style?

3. Tell me about your experiences with industry alignment?
•

Prior to industry alignment did you have any stereotypes and/or preconceived
assumptions of the workers in your assigned industry, the work culture, job duties
etc? From your experience, post industry alignment, are they true/false, and how?

•

In your experience, do these assumptions/stereotypes guide your decisions?

•

How does your familiarity with the industry guide your decisions?

4. Can you describe how meeting the injured worker impacts your return to work
decisions?
•

What kinds of experiences have you had that would suggest meeting a worker has
more/less impact than making decisions based on phone?

•

What is different about meeting a worker? Does the return to work decision
become easier and/or more complicated, how and why?

93

•

How do you feel when a woman cries compared to when a man cries during the
meeting? Does it feel different, how and why?

•

What kind of experiences have you had with meeting a worker where the
behaviors are more typical of men than woman and vise versa?

5. What is your experience with case management?
•

How do you feel case management effects your decision making?

•

What is your experience with the introduction of an injured worker's
psychological-social issues? How does it feel when the non-compensable issues
are introduced for the female worker, male worker?

•

How does it feel when you are making decisions for an injured male/female with a
catastrophic injury?

6. What is your experience with making negative decisions on a worker's claim? Is it
different making a negative decision on a male/female worker, how and why?
•

Can you explain what you do to prepare to render a negative decision to an injured
worker? Do you prepare differently for a male/female injured worker, how and
why?

•

How does it feel when your decisions are challenged by a male/female?

•

In your experience, who take?, more control of their return to work, and who is
more likely to give control to you? Can you explain why you feel this is?

•

In your experience is there a difference in types of trust of the system for
male/female? Can you give me an example of when you have experienced this?

7. What is your experience with the law and policy?
•

Can you explain how the law and policy helps you make return to work decisions?

•

How would you describe the law and policy addresses the individual needs of the
injured worker? Does it address the needs of the male/female injured worker, and
/or is it gender neutral, how and why?

For example, paying for childcare costs, missing time from a program for a
pregnant woman to get an ultrasound vs. man with a flu.
For example, providing counseling for non compensable depression, marriage
counseling, rehab for addictions issues.

94

•

Would you describe the Act as being more paternalistic, maternal, or gender
neutral? Why?

8. Can you explain how your gender as a male/female decision maker influences the
decisions you make on a claim for an injured male/female worker?
•

How would you describe your sense of self awareness regarding gender bias?
Prior to this study, have you ever evaluated your 'attitudes, stereotypes' and how
they impact your professional life? Or do you think gender perceptions have any
impact on making return to work decisions?

•

How does your up bringing, past life experiences with disability and work impact
any tolerances and/or return to work expectations you have of disabled men versus
disabled women?

95

References
Ahlgren, C , Hammarstrom, A. (2000). Back to work? Gendered Experiences of
Rehabilitation. Scandinavian Journal of Public Health, 28(2), 88-94.
Akabas, S. H., Gates, L. B., & Galvin, D. E. (1992). Disability Management: A Complete System
to Reduce Costs, Increase Productivity, Meet Employee Needs, and Ensure Legal Compliance.
New York: AMACON.
Ashbury, F., (1995). Occupational Repetitive Strain Injuries and gender in Ontario: 19861991. Journal of Occupational and Environment Medicine, 37(4), 479-485.
Auer, J., Cunningham, J., Jennings, K. (2003). Gender, Workplace Injury and Return to
Work: A South Australian Perspective. South Australia: WorkCover.
Beach, L. R., & Connolly, T. (2005). The Psychology of Decision Making. California,
USA: Sage Publications Inc.
Bigos, S. J., Spengler, D.M, Marring, N.A (1989). Low Back Pain in Industry: A
Retrospective Study. Spine, 11 (252-256).
Bounds, T., Schopp, L., Johnstone, B., Unger, C , Goldman, H. (2003). Gender
Differences in a Sample of Vocational Rehabilitation Clients with TBI.
NeuroRehabilitation, 18, 189-196.
Brines, J., Salazar, M. K., Graham, K. Y., Pergola, T., & Connon, C. (1999). Injured Workers'
Perceptions of Case Management Services. Journal of the American Association of
Occupational Health Nurses, 47(8), 355-364.
Brodwin, M., Parker, R., DeLaGarza, D. (1996). Disability and Accommodations. In M.
Szymanski, & R. Parker (Eds.), Work and Disability (pp. 166 -203). Texas:Pro-ed.
Chung, J., Donald, C , Clarke, J. (1998). Women, Work and Compensation: A Different
and Changing Experience. Institute for Work and Health: McMaster University.
Creswell, J. W. (1998). Qualitative Inquiry and Research Design: Choosing Among Five
Traditions. Thousand Oaks, CA: Sage Publications.
Creswell, J. W. (2005). Educational Research: Planning, Conducting, and Evaluating
Quantitative and Qualitative Research. Upper Saddle River, NJ: Merrill Prentice Hall
Inc.
Cromie, J., Robertson, V., Best, M. (2003). Physical Therapists Who Claimed Workers'
Compensation: A Qualitative Study. Physical Therapy, 83(12), 1080 - 1089.

96

Crook, J., Moldofsky, H., Shannon, H. (1998). Determinants of Disability After a Work
Related Musculoskeletal Injury. Journal of Rheumatology, 25, 1570-1577.
Dees, J. P., & Anderson, N. L. (1996). Case Management: A Management System for
Quality and Cost Effective Outcomes. Journal of the American Association of
Occupational Health Nurses, 44(8), 385-389.
Dembe, A., (2001). The Social Consequences of Occupational Injuries and Illnesses.
American Journal of Industrial Medicine, 40(2), 403-417.
DiBenedetto, D.V., & Hall, J.C. (1995). Special Report: Workers' Compensation and Disability
Case Management. The Occupational and Environment Medicine Report, 9(12), 93-99.
Dyck, D. (2000). Disability Management: Theory, Strategy and Industry Practice. Toronto:
Butterworths.
Hall, E.M., (1990). Women's Work: An Inquiry into the Health Effects of Invisible and
Visible Labour. Stockholm: Kaorlinska Institute (doctoral thesis).
Hampton, N., Crystal, R. (1999). Gender Differences in Acceptance of Disabilities
Among Vocational Rehabilitation Consumers. Journal of Applied Rehabilitation
Counseling, 30(1), 16-21.
Hanna, W., Rogovsky, E. (1991). Women with Disabilities: Two handicaps Plus.
Disability. Journal of Applied Rehabilitation Counselling, 26, 49-63.
Harder, H. G., Scott, L. R. (2005). Comprehensive Disability Management. Elsevier
Churchill Livingstone
Holgren, K., Ivanoff, D. (2004). Women on Sickness Absence- Views of Possibilities and
Obstacles for Returning to Work. A Focus Group Study. Disability and Rehabilitation,
26 (4), 213-222.
Keetings, M., Smith, O. B. (2000). Ethical and Legal Issues in Canadian Nursing
(2n ed.). Toronto, Canada: Elsevier Science.
Lippel, K. (1995). Watching the watchers: how expert witnesses and decision makers
perceive men's and women's workplace stressors. In K. Messing, B. Neis, and L.
Dumais (Eds). Invisible: Occupational Health Problems of Women at Work, (pp. 265
-291). Charlottetown: Gynergy Books.
Marnetoft, S., Selander, J. (2002). Long-term Effects of Early Versus Delayed Vocational
Rehabilitation: A Four Year Follow Up. Disability and Rehabilitation, 24(14), 741745.

97

Marshall, C , and Rossman, G. R. (1995). Designing Qualitative Research (2n ed.).
Newbury Park, CA: Sage Publications Inc.
Martin, K. J. (1995). Workers' Compensation: Case Management Strategies. Journal of the
American Association of Occupational Health Nurses, 43(5), 245-250.
McMillan, J. H., and Schumacher, S. (2001). Research In Education: A Conceptual
Introduction (5* ed.). New York, NY: Longman Inc.
Menz, F., Hansen, G., Smith, H., Brown, C , Ford, M., McCrowey, G., (1989). Gender
Equity in Access, Services and Benefits from Vocational Rehabilitation. Journal of
Rehabilitation, 55(1), 31-40.
Messing, K., Stellman, J., (1999). Understanding occupational disease in women workers.
In P. Kane, Women and Occupational Health: Issues and policy paper prepared for
the Global Commission on Womens' Health, (pp. 19-25). Geneva: World Health
Organization.
Moustakas, C. (1994). Phenomenological Research Methods. Thousand Oaks, CA: Sage
Publications.
Mullen, J., Roth, B. (1991). Decision Making: Its Logic and Practice. Rowman and
Littlefied Publishers; Maryland.
Ockander, M., Timpka, T. (2003). Womens' Experiences of Long Term Sickness
Absence: Implications for Rehabilitation Practice and Theory. Scandinavian Journal
of Public Health, 31, 143-148.
Ostlin, P., (2000). Gender Inequalities in Occupational Health. Cambridge MA: Harvard
Center for Population and Development Studies. Harvard University Press.
Patterson, J., DeLaGarza, D., Schaller, J. (1997). Rehabilitation Counselling Practice:
Considerations and Interventions. In R. Parker and M. Szymanski (Eds.),
Rehabilitation Counseling: Basics and Beyond, (pp. 269-302). Texas:Pro-ed.
Reed, C. (1999). Women with Disabilities Making the Transition Back to Work:
Psychosocial Barriers and Interventions. Work, 13, p. 227-242.
Salazar, M. K., Graham, K. (1999). Evaluation of a Case Management Project: Summary and
Integration of Findings. Journal of the American Association of Occupational Health Nurses,
47(9), 416-423.
Shrey, D. E. (1996). Disability Management in Industry: the New Paradigm in Injured
Worker Rehabilitation. Disability and Rehabilitation, 18(8), 408-414.
Shrey, D.E., & Lacerte, M. (1995). Principles and Practices of Disability Management in

98

Industry. Florida: GR Press.
Statistics Canada (2005). Canadian Statistics-Experienced labour force 15 years and
over by occupation and participation rate. Retrieved on November 11, 2005, from
http://www40.statcan.ca/101/cst01/labor45c.htm.
Van Manen, M. (1990). Researching Lived Experience. New York: State of New York
Press.
Worksafe BC, (2005). Policy and Research Department. Richmond: Workers'
Compensation Board of British Columbia.
Ziller, R.C. (1990). Environment-Self Behaviour: A General Theory of Personal Control.
Journal of Social Behaviour and Personality, 5(5), 227-242.

99