Introduction

The scope of this chapter is the awareness, recognition and reporting of occupational disease. It includes ways to increase awareness, recognition and reporting and the roles of the various parties. While the inclusion of occupational information in the EMR was initially included in this topic, it will now be covered in a separate chapter under healthcare: occupation in the electronic medical record.

Background

Ontario legislative and regulatory requirements

  • Ontario Health and Safety Act (OHSA)
  • Workplace Safety Insurance Act (WSIA)

Summary of employer reporting responsibilities

  • OHSA s. 51 (2), Notice of occupational illness: if an employer is advised by or on behalf of a worker that the worker has an occupational illness or that a claim in respect of an occupational illness has been filed with the WSIB by or on behalf of the worker, the employer shall give notice in writing, within four days of being so advised, to a Director, to the committee or health and safety representative and the trade union, if any, containing such information and particulars as are prescribed.
  • OHSA s. 51 (3) Subsection (2) applies with all necessary modifications if an employer is advised by or on behalf of a former worker that the worker has or had an occupational illness or that a claim in respect of an occupational illness has been filed with the WSIB by or on behalf of the worker.
  • WSIA – s. 21 (1), An employer shall notify the Board within three days after learning of an accident to a worker employed by him or her, or if the accident necessitates healthcare or results in the worker not being able to earn full wages.
  • WSIA – s. 21 (4), The employer shall give a copy of the notice to the worker at the time the notice is given to the Board.

Summary of worker reporting responsibilities

  • WSIA – s. 22 (1), A worker shall file a claim as soon as possible after the accident that gives rise to the claim, but in no case shall he or she file a claim more than six months after the accident, or, if the case of occupational disease, after the worker learns that he or suffers from the disease.
  • WSIA – s. 22 (2), A survivor who is entitled to benefits as a result of the death of a worker shall file a claim as soon as possible after the worker’s death, but in no case shall he or she file a claim more than six months after the worker’s death.
  • WSIA – s. 22 (7), The claimant shall give a copy of his or her claim to the worker’s employer at the time the claim is given to the Board.
  • WSIA – s. 22 (8), A copy of the claim for an occupational disease must be given to the employer who has the most recently employed the worker in the employment to the nature of which the disease is due.

Summary of physician reporting responsibilities

  • Reg. 490/09 s 29(7), “On advising a worker and the worker’s employer that a worker is fit with limitations or unfit to continue working in exposure to a designated substance, the physician shall promptly communicate that advice to the Provincial Physician.”
  • WSIA s. 37 (1), Every healthcare practitioner who provides healthcare to a worker claiming benefits under the insurance plan or who is consulted with respect to his or her healthcare shall promptly give the Board such information relating to the worker as the Board may require.
  • WSIA s. 37 (2), Every hospital or health facility that provides healthcare to a worker claiming benefits under the insurance plan or who is consulted with respect to his or her healthcare shall promptly give the Board such information relating to the worker as the Board may require.
  • WSIA s. 37 (3), When requested by an injured worker or the employer, a health professional treating the worker shall give the Board, the worker and the employer such information as may be prescribed concerning the worker’s functional abilities. The information must be provided on the prescribed form.

Consultation and review summary

Research highlights

A comprehensive summary of CREOD research is available on the CREOD website.

Awareness

  • A study focused on skin disease in the service sector found employers lacked awareness of occupational diseases.
  • Work was done to create and test awareness or prevention posters for skin disease and HAVS. Feedback from workers was positive, and customization of the posters to their sector and job was important.
  • A study examined the use of narrative versus more visual content to convey basic health and safety information for newcomers and found that visual content was favoured.

Recognition and reporting

  • There are many factors that relate to the recognition and reporting of OD. A qualitative study by Howse, Eakin, House and Holness (Why is occupational disease under-reported, 2009 – funded by WSIB Research Advisory Council) found three groups of factors affected recognition and reporting, including:
    • psycho-social factors such as perception of the seriousness and legitimacy of a condition and knowledge of workplace hazards and the WSIB reporting process
    • workplace cultural factors such as stigma and workplace norms, education and support within the workplace, employer pressure and fear of reprisal
    • systemic and structural factors such as the content and format of WSIB forms, the WSIB’s information requirements for claimants, scientific and policy tensions in adjudication, the existence of employers not registered with the WSIB, financial incentives for employers not to report or to discourage reporting, workplace size and the support provided for workers and knowledge of occupational disease by healthcare providers
  • Ontario-based research has found that even when an occupational diagnosis is clear, a number of workers do not have WSIB claims. For example, several studies of workers with a definite diagnosis of occupational contact dermatitis have reported on WSIB claims submission. A study in 2000 found that at the time of assessment, 41% had a claim. Six months later, after a definitive diagnosis that had increased to 69%. Data from 2012-2016 for those with occupational dermatitis found that overall 52% had a claim filed, with the percentage varying by industry sector.

Reports and reviews

Review of Recommendations from Expert Advisory Panel on Occupational Health and Safety

(Dec 2010)

Following are two of the recommendations that pertain to awareness:

Dean Report Recommendation 3

The new prevention organization should work with other ministries and training organizations to develop a graduated Occupational Health and Safety Awareness and Training Strategy to establish Ontario as a jurisdictional leader in OHS continual learning and training considering:

  • an enhanced standard of awareness and training to raise the health and safety knowledge and skills of all workplace parties and to build support for an effective IRS
  • positive campaigns championing the corporate and societal benefits of a healthy and safe workplace to build public awareness, encourage employers to adopt workplace prevention measures and foster support for prevention-focused public policy
  • phased in on a priority basis
  • include embedded OHS awareness information in school curricula beyond primary and secondary schools
  • work with post-secondary institutions on the curriculum for disciplines including teaching, medicine, nursing, engineering and various vocational programs in colleges
  • provide mandatory training for various workplace parties and for identified high-hazard sectors and jobs
  • use community-based and bridging programs to ensure these workers have greater occupational health and safety knowledge as they enter
Dean Report Recommendation 4

The new prevention organization should develop a multi-year social awareness strategy that will significantly reduce public tolerance of workplace injuries, illnesses and fatalities and shift attitudes, beliefs and behaviours around occupational health and safety.

Stakeholder focus groups

Gap themes
  1. There is a low level of awareness across most workplaces, reflected in both the low demand for OD training and the inconsistent knowledge of prevention requirements and workplace surveillance.
  2. There is confusion about when to report and how and to whom.

Solution themes

  1. Build joint accountability and leadership for “doing something about OD” with the Ministry in the lead, working with employers, trade associations, unions, health and safety system-funded partners.
  2. Promote awareness through a public awareness campaign that is:
    • a multi-pronged approach with multiple distribution channels
    • leverages existing resources
    • reaches young people, those not registered with the WSIB, and newcomers to Canada
    • targets a Day of Mourning on OD deaths
    • teaches about designated substances in schools
  3. Improve information flow to support recognition by developing ways to track individual-level work history, exposures, and symptoms, including, for example,a pocket card as part of WHMIS training to help remind workers and a worker tracking sheet (passport) to update work history/exposures overtime and take to their MD.
  4. Clarify reporting requirements and have the Ministry report back publicly on DS use in the province and control efforts underway and their impact.

Summary review findings

Awareness

  • There is low awareness of OD amongst most OHS parties and HC providers.
  • Various tools have been developed to increase awareness, but these have not been systematically deployed by the OHS system, with the exception of noise-induced hearing loss.
  • The lack of awareness is one of the key reasons for a lack of demand for OD training.

Recognition

  • ODs are under-recognized.
  • Early recognition improves health outcomes for many ODs.
  • Many assume OD recognition rests with physicians, although all OH parties have responsibilities.
  • Methods to increase recognition include information about exposures and disease readily available to workers, employers and healthcare providers.

Reporting

  • ODs are underreported.
  • The mandated reporting roles are outlined in legislation.
  • There remains confusion amongst OHS parties and HC providers about reporting requirements.
  • The OD reporting system to the MLITSD is not standardized and makes data analysis challenging.

Recommendations

System goals

  • increased awareness of the link between exposures at work and health
  • improved OD recognition and reporting by all workplace parties
  • improved physician recognition of the OD

Short term recommendations

1.1 Launch a public OD awareness campaign

Implementation guidance:

  • Immediately standardize OHS OD prevention messaging and branding, beginning with designated substances and respiratory illnesses.
  • MLITSD bring together all parties to develop and execute a multi-pronged public OD prevention awareness campaign.
  • Develop an annual OHS OD prevention campaign targeting one priority per year, starting with silicosis.

1.2 Develop a suite of OD recognition tools

Implementation guidance:

  • Focus on DS and OD reporting to start.
  • Improve the data capture for more effective use in surveillance and prevention
  • Develop a pocket DS resource (reminder) card and electronic reminders (QR codes).
  • Implement a worker information card (passport) for tracking their DS exposures over time.
  • Clarify obligations and legislative reporting requirements for workers, employers and physicians.

Longer term recommendations

1.3 Implement simple self-screening tools for workers starting with lung and skin disease to improve early recognition.

1.4 Develop a shared data strategy between the MLITSD and WSIB.

1.5 Develop technologically enabled tools to assist workers with prevention (e.g. remember about health risks and prevention protocols)