International Journal of Disability, Community & Rehabilitation

Chronic Pain Compensation in Canada

Joanna L. Noonan and Shannon L. Wagner

Abstract

Chronic pain claims pose difficult policy questions for compensation boards and present a fundamental challenge to traditional workers' compensation systems. To ignore emerging medical evidence of the connection between physical injury and the development of chronic pain would violate the "historical compromise" upon which workers' compensation was originally founded. That is, the avoidance of tort litigation by employees against employers in return for compensation of work related injury and disease (Gundersen & Hyatt, 2000). Despite the controversy that surrounds chronic pain and the inherent difficulty in establishing workplace causation, workers' compensation boards across the country have been directed to take an increasingly expansive approach to policies relating to chronic pain. The intent of this paper is to describe the evolution of chronic pain entitlement under workers' compensation policy over the past two decades in the context of two key decisions. The first in 1987, Decision 915 by the Ontario Workers' Compensation Appeals Tribunal (WCAT), now called the Workplace Safety & Insurance Appeals Tribunal (WSIAT), set a precedent for the recognition and compensation of chronic non-organic pain. The second, a 2003 Supreme Court ruling in Nova Scotia, declared limitations on chronic pain compensation to be unconstitutional.

Introduction

Chronic Pain Defined

There is general consensus that chronic pain refers to pain that persists six months after an injury and beyond the expected recovery duration for a comparable injury, or in the absence of a definable injury, pain that persists 6 months after its onset in the presence or absence of a pathological process (Murray, 1995). Chronic Pain Syndrome, Fibromyalgia, Fibromyalgia Syndrome, Lower Back Pain, and Myofascial Syndrome are examples of conditions believed to be included within the category of chronic pain.

The controversy surrounding the legitimacy of chronic pain claims lies largely in the longstanding belief that pain results only from tissue damage. Therefore, in the absence of detectable physical tissue damage, chronic pain is often been viewed as psychogenic, exaggerated, and/or malingered. With evolving concepts of pain however, it is becoming increasingly apparent that chronic pain is the result of complex changes in the pain regulatory system with impacts on the endocrine, immune, endogenous opioid, and nervous system (e.g., Bernard, Sauter, Fine, Peterson, & Hales, 1994; Henning & Sauter, 1996; National Institute for Occupational Safety and Health [NIOSH] review, 1997; Ontario Workplace Safety & Insurance Board [WSIB], 2000 Feb). As such, we should not assume that the biomedical approach taken in the treatment of acute pain can successfully be applied to the management of chronic pain. As Murray (1995) notes, chronic pain is unlike acute pain in that it responds poorly to traditional pain therapies such as analgesics and narcotics, and rarely has an identifiable cause. In fact, only one-third of chronic pain patients are able to attribute the onset of their pain to a specific injury or event (Murray, 1995).

The difficulty in identifying cause, along with the lack of objective medical findings and inability to clearly determine the contribution of psychological and social factors in the development of chronic pain, further complicates the issue of chronic pain compensation in the workplace. Although such psychosocial contributors are only recently being investigated as factors involved in the development and prognosis of chronic pain, several important studies provide guidance as to their respective effects. Specifically, with regard to psychological factors, depression, dysthymia and anxiety have been suggested as important co-morbid counterparts of chronic pain (e.g., Atkinson, Slater, Grant, Patterson, et al., 1998; Brown, 1990) as well as its reported levels of intensity and impairment (Haythornthwaite, Sieber, & Kerns, 1991). Additionally, Crook, Moldofsky, and Shannon (1998) found that similar psychosocial factors predicted poorer follow-up prognosis, as well as reduced rates for return to work.

Other psychosocial factors of importance related to the development of long term disability and pain include increasing age (e.g., Cheadle, et al., 1994; Volinn, Van Koevering, & Loeser,et al., 1991), lower socio-economic status (e.g., Deyo & Diehl, 1998; Deyo & Tsui-Wu, 1987; Volinn, et al., 1991), length of time off work and pain characteristics. In particular, Waddell (1992) suggests that the longer an employee is off work due to disability, the less chance he/she will return. This author states that there is probability of 70 percent return to work after two months, but that this rate drops to 50 percent at six months, and then to 30 and 10 percent at twelve months and two years, respectively. In reference to pain characteristics, the intensity of pain (von Korff, Wagner, Dworkin, & Saunders, 1991) as well as the number of painful sites (van Korff, Dworkin, Leresche, & Kruger, 1988) have both been associated with the development of long term pain (for an excellent summary of predictors, prognosis and treatment evaluation for chronic pain the reader is referred to Tunks, Crook & Crook, 2000).

Costs of Chronic Pain

Chronic pain creates significant economic burden in terms of lost productivity, compensation, and legal and health care costs. Millar (1996) reported that 3.9 million Canadians, or 17% of the population, suffer from chronic pain with the most common causes related to back and rheumatoid conditions. Although epidemiological studies have failed to demonstrate significant changes in the prevalence of low back pain over the past 40 years, there has been a marked increase in back pain within the workplace itself. In fact, back pain accounts for over 50% of chronic musculoskeletal disabilities in the workplace (Clinical Standards Advisory Group, 1994). From a workers' compensation perspective the Ontario Workers' Compensation Board (WCB) compensated 1500 chronic pain claims in 1990 and has projected 2014 costs to be in the range of 100 million dollars (Ontario WSIB, 2000 Aug). Although less than 10% of patients suffering from acute pain eventually develop chronic pain, chronic pain accounts for three-quarters of total health care and compensation costs (MacKinlay, 1996) and in 94% of chronic pain cases treatment is ineffective in reducing the degree of suffering (Moulton, 2002). Overall, economic costs of chronic pain to the Canadian economy are startling, having been estimated at nearly 4 billion dollars per year in the form of disability payments, lost income, and medical costs (Kenter, 1992).

Provincial Compensation Rulings

Prior to 1987, provincial workers' compensation legislation had no special provisions for the compensation of chronic pain. Compensation was awarded on the basis of an identifiable "injury" and not a "disability." Decision 915 (1987) by the Workers' Compensation Appeals Tribunal (WCAT) provided the impetus for change in workers' compensation philosophy and policy with its recognition of chronic non-organic pain or "psychogenic disability" as a compensable injury.

In Decision 915, the Tribunal defined chronic pain as "enigmatic chronic pain" (p. 6) persisting beyond expected healing time for which there was no known organic pathology (WSIAT, 1987). This included pain caused by unknown pathology as well as pain of a psychological origin. Although the WCB of Ontario did compensate disabling pain related to Post Traumatic Stress Disorder and Conversion Disorder, enigmatic chronic pain was not compensated at the time. After all, chronic pain was not viewed as a "real" disability since it was believed to be within the worker's control and predominantly related to secondary gain factors. In Decision 915 however, the tribunal recognized psychogenic pain disorders as legitimate conditions that are as involuntary as other physical injuries. Moreover, chronic pain is sometimes believed to be attributable to organic causes that simply cannot be diagnosed. Specifically, 10% of patients referred to pain clinics are eventually diagnosed with an organic pathology (The Modern Synopsis of Psychiatry IV as cited in WSIAT, 1987) and 5% of vertebral fractures are undiagnosed on x-ray (WSIAT, 1987). Consequently, the tribunal held that the diagnostic limitations of medical science should not be reason for barring consideration or exclusion of chronic pain claims.

Having established that chronic pain is "real," the next issue the tribunal addressed was whether there existed a causal connection between chronic pain and the workplace. In other words, addressing the issue of whether the chronic pain disability resulted from a compensable injury. Several factors were presented as arguments against work relatedness. The first pertains to the role of predisposing factors in the development of chronic pain disorders in the workplace. Predisposing factors are those factors that have no connection with the workplace and can include such things as the worker's emotional state, as well as personal factors such as level of education, lack of skills, and/or lack of social support. On this matter the tribunal concluded that such factors are irrelevant based on the concept of the "thin skull doctrine" which, in the court system, rests on the premise that the defendant is liable for the full extent of the injury despite the plaintiff's susceptibility (WSIAT, 1987). In other words, the employer assumes liability for an employee's predisposing risk factors. Failing to apply the thin skull doctrine to workers' compensation cases would reduce the protection that the workers' compensation system was intended to provide. Moreover, it would be inappropriate to deny compensation after injury based on pre-existing conditions that did not affect the employment relationship prior to injury (WSIAT, 1987).

To further establish the connection between chronic pain and work, the tribunal explored the issue of entitlement to compensation for consequences. In the Ontario Workers Compensation Act (WCA) entitlement depends on the disability having "resulted from" the injury. The tribunal interpreted the concept of "resulting from" an injury to infer a relatively broad-based workplace connectedness. Accordingly, they went on to say that a disability is deemed to result from an injury if the injury made a "significant contribution" to the development of the disability, even where it may not have been the sole cause (WSIAT, 1987). Once again, this approach models that of the court system where the defendant is liable for injury if their negligence made a material contribution to the injury sustained. If however it can be shown that some other contributing factor was significant enough to cause the injury, it would be deemed an "intervening cause" and the chain of causation would be broken; work relatedness could therefore not be established.

The tribunal examined other controversial issues including the impact of motivation and secondary gain, the lack of objectivity in validating chronic pain conditions, and the potential for malingering. With the incidence of malingering estimated to be only 1-2% of cases and the strong likelihood that secondary gain would be uncovered upon close examination, the tribunal resolved that such challenges are insufficient reason to broadly refuse compensation for chronic pain claims. The tribunal concluded that chronic pain conditions arising from employment were compensable subject to genuineness and willingness to seek rehabilitation (WSIAT, 1987).

The tribunal subsequently recommended additions to Ontario's Workers' Compensation Act (WCA) to reflect the coverage of chronic pain disabilities. In doing so, the tribunal recommended several policy considerations regarding chronic pain entitlement including: 1) the original injury should be a significant contributing factor, 2) the worker's pain and resulting disability must be genuine, 3) under-motivation must not be so significant as to become an intervening cause, and 4) there must be no other unconnected causes so significant as to break the chain of causation (WSIAT, 1987). With this, the Ontario WCB set out to develop a chronic pain policy.

In the early 1990s other provincial compensation boards including British Columbia, Alberta, and Newfoundland adopted similar chronic pain provisions. Rather than developing such formal chronic pain policy, other provinces dealt with chronic pain cases on an individual basis and did not explicitly include, nor exclude, chronic pain in their legislation. Nova Scotia provided permanent benefits for chronic pain only in cases where there existed objective physical findings (WCB of Nova Scotia, 2001). New Brunswick was the only province where chronic pain was expressly non-compensable (Murray, 1995).

As boards began to formulate policy and deal with chronic pain claims, several issues consistently surfaced creating challenges for adjudicators. The fact that chronic pain relied heavily on the subjective reports of the claimant created significant difficulties in assessing the degree of disability. With treatment of chronic pain disorders proving to be minimally successful, return to work rates for chronic pain claimants were poor, resulting in concerns regarding the long-term financial viability of compensating chronic pain (Murray, 1995). On the heels of a 1994 Workers' Compensation Appeal Board decision that adopted the criteria established in the WCAT Decision 915, and in an effort to better understand chronic pain, its connection to the workplace, and strategies to effectively prevent and treat it, the Workers' Compensation Board of Nova Scotia (WCBNS) commissioned a report from Dr. Jock Murray, a neurologist at Dalhousie University. Murray (1995) emphasized the importance of a preventive and multidisciplinary approach to address the complexity and multifaceted nature of chronic pain. It was Murray's recommendations that became the foundation for the WCBNS's 1996 chronic pain policy. Although non-organic chronic pain became recognized under Nova Scotia's Functional Restoration Program (FRP), a time-limited rehabilitation program, workers were only eligible for compensation when chronic pain was supported by significant and objective physical findings (WCB of Nova Scotia, 2001). Nova Scotia's FRP focused on limiting the impact of pain on return to work through early intervention and was offered in two phases. Phase I provided work conditioning, education, and a maximum of 12 psychological counseling sessions. For workers who continued to identify pain as a barrier to return to work, Phase II provided an additional 4 weeks of intensive, multidisciplinary pain targeted services. Following program completion, clients were ineligible for additional benefits or pain services (WCB of Nova Scotia, 2000). The FRP was originally approved as a 3-year pilot project to be reviewed annually. Program evaluation in 1999 that revealed return to work rates of 48% after completion of phase I, and 56% after completion of both phases, resulted in continuation of the FRP (WCB of Nova Scotia, 1999).

Nova Scotia's approach to chronic pain was markedly different from that in Ontario where chronic pain was compensated in a similar manner to other workplace injuries. Workers were eligible for benefits where chronic pain resulted from an occupational injury, where pain persisted beyond 6 months, and where pain was inconsistent with organic findings and impaired the worker's earning capacity (WCB Operational Manual as cited in Ontario WSIB, 2000 Aug). Although Alberta compensated non-organic chronic pain, standardized testing by the board was required in order to demonstrate marked life disruption ("Malingering or chronic", 1995). In British Columbia, chronic pain was dealt with under the general policy provisions of psychological impairment ("Malingering or chronic", 1995).

In 1997, the Ontario WCB proposed Bill 99, the Workers Compensation Reform Act. In addition to many changes including a name change to the Workplace Safety and Insurance Board (WSIB), the Bill proposed a new chronic pain approach based on the Jackson Report entitled "New Directions for Workers Compensation Reform." The Jackson Report recommended establishing the specific conditions under which chronic pain would be compensable and limiting benefits to a specific period based on usual healing with no benefits payable beyond this time (Ontario WSIB, 2000 Aug). The Board's proposal under Section 14 of the Workplace Safety and Insurance Act (WSIA) modeled the approach taken in Nova Scotia. It imposed limitations on compensation and identified specific circumstances under which chronic pain compensation would be allowed. Section 14 reads: "A worker is entitled to benefits under the insurance plan for chronic pain as defined in the regulations but only in such circumstances as may be prescribed. The benefits to which the worker is entitled for chronic pain are subject to such limits and exclusions as may be prescribed" (p. 1). Based on the outcome of government public hearings, proclamation of Section 14 of the WSIA was delayed pending the outcome of an independent chronic pain study by the WSIB. No change in chronic pain policy would follow until after the report (Office of the Employer Advisor, 1997).

Although the Chronic Pain Study Panel reached consensus on the prevention and management of chronic pain during the first 12 months post-injury, they were unable to agree on the approach to compensation beyond 12 months. Instead, the Panel presented two options for consideration. Under Option A, a worker would be assessed after 12 months for a permanent impairment that would recognize both the organic impairment and the pain rating (Ontario WSIB, 2000 Aug). Essentially this option would provide the same opportunities for entitlement as those available to other injured workers. Option B, with a focus on early intervention and treatment, would limit benefits to 12 months after which no further benefits would be payable (Ontario WSIB, 2000 Aug). The precedence set by the WCAT Decision 915 in compensating chronic pain injury without imposed restriction, along with the increased recognition of chronic pain by the Canadian court system, are arguments offered in favour of Option A. Proponents of Option B on the other hand, suggest that the WCAT Decision 915 has forced unlimited and unmanageable compensation for long-term chronic pain in the absence of organic cause and without a clear linkage to the workplace. From this standpoint, restriction on compensation through Option B would be a more reasonable and sustainable approach.

After consideration of all available information, the Report of the Chair of the Chronic Pain Panels recommended that WSIB continue to treat chronic pain as any other workplace injury or illness (Ontario WSIB, 2000 Aug). In addition it recommended a review in five years time. Such a review would serve several purposes. It would evaluate the effectiveness of the WSIB's prevention and management strategies, would consider new evidence pertaining to chronic pain and its relation to the workplace, and finally, it would review developments in chronic pain case law (Ontario WSIB, 2000). These recommendations have essentially become the present day chronic pain policy in Ontario.

Shortly after the results of the Ontario Chronic Pain Study were released, a decision by the WCAT in Martin v WCB of Nova Scotia, found section 10B of the Act to be unconstitutional related to the limitations it imposed on compensation. In excluding chronic pain the Act was found to violate the Charter of Rights and Freedoms which guarantees equal rights regardless of age, sex, race, colour, national or ethnic origin, or mental or physical disability (Department of Justice, 1987). Regulations under the Board's Functional Restoration Program (FRP), which provided four weeks rehabilitation after which no further benefits were payable, were also deemed unconstitutional. The Martin case subsequently went on to the Nova Scotia Court of Appeal and the Supreme Court of Canada, which will be later discussed.

In the midst of the Martin v WCB of Nova Scotia appeal, the British Columbia WCB expanded and clarified their position on chronic pain, aware that any exclusion on chronic pain entitlement under permanent partial disability could be challenged under section 15 of the Charter. Effective January 2003 the British Columbia WCB enacted it's expanded chronic pain policy. Noteworthy changes include the fact that chronic pain would no longer be adjudicated as a psychological impairment. In addition, temporary benefits would be payable for disabling chronic pain amenable to treatment, and workers experiencing permanent chronic pain related to either a physical or psychological occupational injury could be awarded a permanent partial disability benefit under section 23 of the Act. The new policy distinguishes between two types of Chronic Pain Syndromes, including Specific Chronic Pain and Non-specific Chronic Pain, providing entitlement for both. In addition to a broader entitlement for chronic pain, early intervention and treatment became key priorities under the new policy. In all cases where pain has persisted beyond 6 months and is deemed "chronic," a multidisciplinary assessment will be conducted. This assessment will not only assist the Board in determining the extent of the chronic pain disability and it's relation to the workplace, but will be instrumental in developing appropriate treatment (WCB of British Columbia, 2003).

Supreme Court Decision

While several jurisdictions have developed and revised policies on chronic pain compensation in the workplace, the recent 2003 Supreme Court Ruling in Martin v WCB of Nova Scotia will undoubtedly have broad implications for the Canadian Workers' Compensation System. The Supreme Court, ruling in favour of the WCAT and against the Nova Scotia Court of Appeal, reached a unanimous decision that the exclusion of chronic pain from the Act was unconstitutional. This exclusion failed to provide equal access to workers' compensation benefits for workers sustaining chronic pain injuries and limited benefits to a fixed amount (Supreme Court of Canada, 2003). The Court has ordered provinces with exclusions and/or limitations on chronic pain to formulate new policies within 6 months.

The first issue the Supreme Court addressed in the Martin appeal was whether the Workers' Compensation Act (WCA) and regulations under the Functional Restoration Program (FRP) imposed "differential treatment" on the basis of disability, an enumerated ground under section 15 of the Charter. By excluding chronic pain from the general provisions under the WCA, and limiting benefits to a 4 week FRP, the Court found that differential treatment did in fact exist. Subjecting all chronic pain claimants to an identical and limited benefit scheme without acknowledging individual needs was deemed discriminatory. Specifically, although Martin was diagnosed with chronic non-organic pain, he was deprived of temporary earnings replacement and medical treatment benefits to which workers suffering from other conditions would normally have been entitled.

In proving whether discrimination was "substantive," and therefore demeaning to human dignity, the Court applied four contextual factors including 1) the existence of a pre-existing disadvantage, vulnerability, stereotyping or prejudice toward the person or group, 2) the correspondence, or lack thereof, between the prohibited ground and the actual needs and circumstances of the group or person, 3) the ameliorative effect of the legislation upon a more disadvantaged group, and 4) the interest affected by the legislation (Supreme Court of Canada, 2003). With regard to whether a pre-existing disadvantage exists, the Court found that the common misconceptions surrounding chronic pain, it's legitimacy, and the perception that it's often times a psychological disorder or case of malingering, did in fact constitute a disadvantage.

On the matter of the association between the ground of discrimination, the chronic pain disability, and the actual needs of the worker, the Court found the second contextual factor to be met as well. The Board's negligence in providing temporary earnings replacement, permanent impairment benefits, vocational rehabilitation and training, and medical aid benefits, and their exemption from re-employment and accommodation obligations, clearly amounts to discrimination. While the Court acknowledged that the principle of early intervention via the FRP was sound, they noted that a significant portion of chronic pain injuries can develop into permanent and considerable disabilities for which the Act is clearly unresponsive (Supreme Court of Canada, 2003).

In examining the ameliorative effect of the legislation upon a more disadvantaged group, the Court found no such ameliorative purpose, thus satisfying the third contextual variable. Although the Court concurred that the workers' compensation resources should be allocated based on priority needs, the Board's lack of provision for chronic pain entirely ignored the needs of this group as a whole (Supreme Court of Canada, 2003).

Finally, on the fourth contextual factor, the nature of the interest the legislation impacts, the Court found that the loss in benefits, particularly for workers permanently impaired by chronic pain injuries, is no small matter. In failing to adequately compensate chronic pain injuries the Act reinforces the belief that chronic pain is not a valid condition (Supreme Court of Canada, 2003).

Having established that Section 10b of the WCA did in fact violate the Charter, the court went on to determine whether these violations could be justified as prescribed by law (section 1 of the Charter). Arguments submitted by the Board as justification for violation of the Section 15 of the Charter included the need to ensure viability of the accident fund, the need to follow a consistent approach in the adjudication of chronic pain claims in light of their highly subjective nature, the need to avoid fraudulent claims, and the desire to prevent reliance on benefits through the provision of early intervention afforded through the FRP. In response to these submissions the Court noted that financial concern, in and of itself, is insufficient reason to violate the Charter. Similarly, the Court found that establishing a consistent legislative approach in the management of chronic pain claims is not substantial enough to override the Charter. Although the Act and regulations under the FRP are "rationally connected" to the Board's goal of avoiding fraudulent claims, the Court found that such provisions significantly impair equality rights for chronic pain claimants by assuming that all chronic pain claims are fraudulent. Finally, on the issue of early medical intervention, the Court found that the early intervention provided by the FRP does not meet the general test of proportionality. In other words, there is no evidence, including that provided in Dr. Murray's report to the Board that suggested time limited benefits would better achieve return to work (Supreme Court of Canada, 2003). The Court subsequently concluded that infringement of the Charter did not constitute a reasonable limit prescribed by law.

This landmark decision conveyed two key messages. First of all, workers with chronic pain injuries must have equal access to workers' compensation just as any other injured worker. Secondly, individual assessments must be undertaken to determine appropriate treatment plans and eligibility for compensation (WCB of Nova Scotia, 2004).

Implications

In response to this decision, the WCB of Nova Scotia has made numerous recommendations to assist the Government of Nova Scotia in developing a chronic pain policy that is in compliance with the Supreme Court ruling. With early intervention and treatment believed to be the optimal approach in the management of chronic pain, the Board has recommended the elimination of the FRP as a separate entity, instead integrating it into the regular case management plan (WCB of Nova Scotia, 2004). This approach would better ensure that workers with chronic pain injuries would be entitled to similar workers' compensation services and benefits as other injured workers. Though regulations under the FRP limited benefits, thereby precluding equal access, the principles and philosophy of the FRP were not under appeal and for this reason it will remain an integral component of chronic pain rehabilitation (WCB of Nova Scotia, 2004).

In an effort to effectively evaluate the impact of chronic pain and subsequent entitlement for permanent benefits, the WCB has recommended the use of a modified version of the American Medical Association (AMA) Guide to the Evaluation of Permanent Impairment, 5th edition (WCB of Nova Scotia, 2004). Although other assessment tools were considered, the AMA Guide, 5th edition was found to be the most objective and comprehensive tool for evaluating chronic pain impairment. Because Fibromyalgia, Myofascial Pain Syndrome, and Chronic Pain Syndrome would be ineligible for permanent benefits under the AMA Guide, 5th edition, the Board goes one step further by recommending use of a modified version. In doing so, pain "syndromes" would become eligible for compensation, thereby eliminating differential treatment (WCB of Nova Scotia, 2004). Along this same vein, the Board has recommended that in situations where chronic pain claims have been closed, despite an identified need for medical treatment, retroactive medical aid benefits would be awarded (WBC of Nova Scotia, 2004).

Finally, it has been recommended that section 10B of the Nova Scotia WCA and the regulations under the FRP be rescinded and replaced with a statement reflecting equal treatment for chronic pain injuries (WCB of Nova Scotia, 2004). The legislature has done exactly this with Bill 20 which recognizes chronic pain as a "personal injury" under the Act (Government of Nova Scotia Legislature, 2003). Bill 20 is expected to pass its final reading in the near future.

Conclusion

In summary, the WCAT Decision 915 (1987) was truly instrumental in recognizing and validating the legitimacy of chronic pain injuries under workers' compensation law in Canada. Subsequent to this decision, provincial boards began to formulate initial policies to address the compensation of chronic pain. While several jurisdictions provided no provisions for chronic pain, others provided compensation on a limited basis. Even today, Alberta, Newfoundland, and Manitoba have no chronic pain legislation, while Saskatchewan, PEI, Northwest Territories and the Yukon provide no permanent benefits for chronic pain (WCB of Nova Scotia, 2004). The more recent Supreme Court decision in Martin v WCB Nova Scotia requires provinces to amend compensation laws to permit chronic pain claims. Perhaps of even greater significance, is the broader range of responsibilities that it bestows on Workers' Compensation Boards across the country. The requirement for provisions under workers' compensation to be equitable for all workplace injuries alike, undoubtedly leads to an expanded liability for workers' compensation boards, with an effect that is yet to be realized.

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Submitted by

Joanna Noonan is an Occupational Health Nurse at Procter and Gamble, as well as a student in the Master's of Arts (Disability Management) at the University of Northern British Columbia. Email: joanna.n@sympatico.ca

Shannon Wagner is an Assistant Professor in the Disability Management Program at the University of Northern British Columbia (www.unbc.ca/disabilitymanagement). Email: wagners@unbc.ca

Correspondence may be addressed to the second author at University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, V2N 4Z9, phone 250 960-6320, fax 250 960-5744.

Appreciation is extended to the anonymous reviewers who provided helpful advice on a previous version of this article.

Keywords

chronic pain; workers' compensation; entitlement; Canadian policy; psychosomatic illness; malingering; organic injury

International Journal of Disability, Community & Rehabilitation
Volume 4, No. 1 Canada
www.ijdcr.ca
ISSN 1703-3381

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