Paper: Role of physicians in workers’ compensation systems in Québec and Ontario: Relevance for research and practice in return to work

Author(s) and Affiliation(s):
Katherine Lippel, University of Ottawa
Joan Eakin, University of Toronto
Linn Hollness, University of Toronto
Dana Howse, University of Toronto
Day/Time: Friday at 13:30
Room: Ballroom, 2nd Floor

Physicians are known to play a significant role in return to work (RTW), and interactions with compensation systems may affect the therapeutic relationship. This study compares the legal and policy frameworks governing workers’ compensation in Québec and Ontario in order to identify similarities and differences that could affect the practices of physicians involved in the compensation process and their role in the RTW process.


Workers' compensation legislation, policy and appeal tribunal decisions of two provincial systems (Quebec and Ontario) were analyzed in order to identify the roles, responsibilities and powers of physicians in each system. The study examined, notably, the role of the "physician in charge of the worker" (the physician chosen by the worker for treatment, who plays a role circumscribed by legislation), and compared it to the role of physicians in Ontario. It was postulated that system differences affect not only the identification of relevant actors and stakeholders in RTW, but also research design and the comparability of outcome measures. Findngs were analyzed from a transdisciplinary and inter-jurisdictional perspective; the authors include a physician and two sociologists from Ontario and a lawyer from Quebec. The analytic process involved systematic iterative comparison of key structural and discursive features of the two systems and conceptualization of the implications for doctors' practices and workers' experience.


In Québec, the opinion of the “physician in charge of the worker,” as to diagnosis, treatment, date of consolidation of injury, functional limitations and permanent disability is binding on the compensation board (it may not set aside that opinion at its sole discretion without submitting the matter to medical arbitration). In Ontario, the compensation board is not bound by the opinion of physicians. Workers in Québec may not contest the opinion of their treating physician, while workers in Ontario are free to do so. Treating physicians’ approval of early RTW strategies are mandatory in Québec but not in Ontario.


The variation in physicians’ roles affects a variety of issues of concern for researchers and practitioners in RTW, including treatment choices, support for RTW, and access to vocational rehabilitation. For example, it is more difficult for the compensation board in Québec to question prescribed physiotherapy than it is in Ontario. Interprovincial comparisons of physiotherapy costs for work-related injury without consideration for system differences could lead to the conclusion that Québec doctors prescribe physiotherapy more often when, in fact, it may be that doctors have similar prescription practices but in Ontario the system does not follow through with their recommendations.


Franche, R.-L., Cullen, K., Clarke, J., Irvin, E., Sinclair, S., Frank, J., et al. (2005). Workplace-Based Return-to-Work Interventions: A Systematic Review of the Quantitative Literature. [Journal article]. Journal of Occupational Rehabilitation, 15(4), 607-631.
Kosny, A., Franche, R. L., Pole, J., Krause, N., Cote, P., & Mustard, C. (2007). Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury. Journal of occupational rehabilitation, 16(1), 27-39.
Russell, G., Brown, J. B., & Stewart, M. (2005). Managing injured workers: Family physicians' experiences. [Research]. Canadian Family Physician, 51, 78-85.