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January 30, 2007
The consequences of underreporting workers' compensation
Canadian Medical Association JournalAaron
Thompson is a fourth year Occupational Medicine Resident with the Department of
Occupational and Environmental Health, St. Michael's Hospital, Toronto, Ont.
Correspondence to: Dr. Aaron Thompson, Department of
Occupational and Environmental Health, St. Michael's Hospital, 30 Bond Street,
Toronto ON M5B 1W8; fax 416 864-5421;
In 2004, 977 184 claims, including 920 relating to
fatalities, were made to workers' compensation boards in
Canada.1 It has been estimated that
40%50% of work-related injuries in Canada go unreported, which
suggests that the actual number of work-related injuries in 2004 was
much higher.2,4 From a financial perspective,
underreporting means that funding for medical costs that should be
paid for by workers' compensation boards3 are actually paid by the provincial governments.
From a preventive medicine perspective, employers are not aware
of the full cost of injuries and illness that occur in their
workplace, and thus they may not invest adequately in preventive
health and safety measures.
It has long been recognized that work-related injuries are
underreported to workers' compensation boards, yet a review of the
literature provides few empirical data. A study of Canadian
households in 2002 revealed that 40% of eligible workplace injuries
were not reported,2 and a survey of
physicians in 2003 found that 208 of 384 (54%) of work-related
injuries were inappropriately billed to the public health care
system and not to workers' compensation boards.4 These statistics refer only to work-related
injuries; work-related illnesses are underreported to an even
Health care funding represents a substantial portion of
government spending. The defraying of costs for work-related
injuries and illnesses can be resolved by appropriate reporting and
billing of work-related injuries and illnesses. Employers pay
premiums for workers' compensation coverage, and the amount paid is
linked to their organization's safety record.6 When provincial health insurance is billed
instead of workers' compensation, the workers' compensation
insurance system is undermined and becomes less efficient.
Underreporting results in employers not realizing the true costs of
injuries and illnesses for which they are responsible, leaving the
bill to be paid by the public health care system.
The negative effect that underreporting has on preventive
health and safety measures in the workplace is more damaging than
the financial consequences. Employers are guided by injury and
illness statistics in designing and implementing workplace health
and safety programs, and if employers are not fully aware of
the events that occur in their workplace, preventive efforts
may become less of a priority.7 This
is particularly important with respect to occupational illnesses,
because the timely identification of causal factors for illnesses
such as asthma and dermatitis can have a drastic effect on
Although each province has its own workers' compensation
board and reporting requirements, a claim can generally be filed
by 1 of 3 people: the employer, the employee or the physician.
The employer is legally responsible for reporting work-related
injuries; however, the incentives for not reporting a work-related
injury or illness make this avenue potentially unreliable. Thus,
it is often up to the employee to file his or her claim. There
are many reasons an employee might decide not to file a claim,
ranging from fear of reprisal and social stigma to a lack of
understanding of the compensation system. In a survey of unionized
autoworkers in Michigan in 2000, Rosenman and colleagues found
that 59.1% of workers believed that their injury was not serious
enough to report and 35.9% of workers said they did not report
their injury because their medical expenses were covered by
other insurance programs.8 The belief
that an injury is not serious enough to be reported results from a
lack of knowledge of reporting requirements.
The responsibility for filing claims also rests with
physicians; however, some physicians may feel that they are in a
difficult position. A physician may feel caught in the middle: some
patients may press for their physician to file a seemingly
unjustified claim and other patients may ask their physician not to
file a claim because of fear of reprisal from the employer. In
the former case, physicians must realize that they are not
being asked to determine the outcome of a claim, but merely to
provide factual information to allow the compensation board to
make a decision. In the latter case, physicians should explain
to the patient the importance of reporting work-related
injuries and illnesses.
Physicians usually seek the patient's consent for
reporting a work-related injury or illness, although in some
jurisdictions and scenarios this is not required. Thus, physicians
should be aware of the legislation that governs reporting
requirements in the province where they practise. It is also
important to note that, in theory, it could be considered fraudulent
to bill medicare for work-related consultations, because the
Canada Health Act specifically excludes payment for any service
that is eligible to be paid for by workers' compensation
insurance. As noted by Murphy in a paper on cost shifting in health
care,4 the Canada Health Act does
not allow physicians or patients to request that the government pay
for health care services for work-related injuries or
Physicians are in a unique position to offer education and
assistance to their patients on these matters. Primary prevention
benefits us all: prevention reduces the burden of injury and
illness among workers and our medical system saves public funds
and resources. Inappropriate billing of work-related injuries
and illnesses to the public health care system is a cost that
can and should be controlled. Increased reporting of
work-related injuries and illnesses will have a favourable effect on
the financial state of our health care system and will increase
health and safety awareness in the workplace. Physicians can
play a lead role in improving the proportion of work-related
injuries and illnesses that are reported by encouraging and
helping patients to file claims for work-related injuries and
This article has been peer
interests: None declared.
- Association of Workers' Compensation Boards of
Canada (AWCBC). Workers' Compensation Board/Commission, Financial and
Statistical Data. Key statistical measures for 2004. 2005. Available:
(accessed 2006 Dec 11).
- Shannon H, Lowe GS. How many injured workers
do not file claims for workers' compensation benefits? Am J Ind Med
- Canada Health Act. RSC 1985, c. C-6.
- Murphy B. Cost shifting in health care: a
pilot study explores the relationships between cost shifting, repetitive strain
injury, the Workplace Safety and Insurance Board of Ontario, and publicly
funded health care [dissertation]. Toronto: York University;2003.
- Biddle J, Roberts K, Rosenman KD, et al. What
percentage of workers with work related illnesses receive workers' compensation
benefits? J Occup Environ Med 1998; 40:325-31.[CrossRef][Medline]
- Fortin B, Lanoie P. Centre interuniversitaire
de recherché en analyse des organizations (CIRANO). Effects of workers'
compensation: A survey. 1998. Available:
(accessed 2006 Dec 11).
- Azaroff LS, Levenstein C, Wegman D.
Occupational injury and illness surveillance: Conceptual filters explain
underreporting. Am J Public Health 2002;92:1421-9.[Abstract/Free Full Text]
- Rosenman KD, Gardiner JC, Wang J, et al. Why
most workers with occupational repetitive trauma do not file for workers'
compensation. J Occup Environ Med 2000;42:25-34.[CrossRef][Medline]
January 30, 2007;
176 (3). doi:10.1503/cmaj.060953.