If we list the systems currently being attempted in relation to return to work, there are subsidies for alternative manpower and return to work in relation to returning to the original workplace, and job adaptation benefit, rehabilitation exercise benefit, job support programs, and vocational rehabilitation benefits. There is also a vocational training system, a reemployment support system, etc., and a co-worker harmony program is also implemented to help injured workers return to work. In Incheon and Ansan Labor Welfare corporation Hospital, case management programs for injured workers returning to work are being operated to provide customized case management related to rehabilitation and return to work in consideration of the work characteristics of the workers. However, how these policies are being operated in reality, what proportion of the workers these programs have been applied to, when these programs have been difficult to operate are not reported. According to a study by Lee Jeong-hwa (2017), in 2016, the rate of return to the original work was 41.4%. This rate was 53.5% in workplaces with more than 100 workers and 30.8% in workplaces with less than 5 employees. Regular workers showed 62.8%, while temporary workers 33.2%, and daily workers 12.7%.

Smaller workplaces and non-regular workers have significantly lower rate of return to work. According to the Business Yearbook of Industrial Accident Insurance, the return to original work rate in 2017 was 41.6% and 42.5% in 2018. Few workers benefit from policies being attempted to help return to work, and no policies have been proposed which takes into account the factors affecting return to work such as characteristics of workers, workplaces, industries, and disability. The customized return to work case management program by the Korea Labor Welfare Corporation hospital seems to be the most active type of the projects within the current system, but very few workers could participate in this program, and the program is limited mainly to musculoskeletal diseases.

The promotion of rehabilitation and return to work starts from improving compensation for occupational injury

It is difficult to provide institutional support for rehabilitation or return to work to workers who are not compensated as industrial accidents by the governmental system. Claiming for workers’ compensation threatens job security in some workplaces. Those vulnerable workers tend not to file for workers’ compensation to maintain employment. But they can lose their jobs any time due to health problems from work.

The industrial accident rate in Korea is 0.58% in 2019. This rate is much lower than in Germany and Canada, in which the rates are around 3%. On the contrary, the death rate of industrial accidents is 1.08 per 10,000 persons, the highest among major OECD countries. Considering the fact that death from work is hard to conceal, the remarkably low accident rate means that lots of occupational accidents have been concealed in Korea.

Recently, it was reported in the media that the number of subcontracted workers at the shipyard workplace is twice as many, but the reported incidence of industrial accidents is half as the original contractor workers. This shows the reality of industrial accident concealment that the injured workers and subcontracted companies are disadvantaged by reporting their injuries. The concealment of industrial accidents leads to various problems such as distortion of preventive measures by distorting the size of the problems and hindrance of proper treatment, rehabilitation, return to work, and prevention of industrial accidents.

Intervention for rehabilitation and return to work must start when the accidents occur

Rehabilitation and return to work do not begin at the end of the treatment period. They must start from the point that an industrial accident occurs. At the time of an industrial accident, the identity of an injured worker is 99% patient and 1% worker, and it becomes 1% patient and 99% workers when the treatment is over. In this process, the identity of the patient and the identity of the workers are continuously changing.

It is too late if the intervention for rehabilitation and return to work begins at the end of treatment. You cannot expect good quality. We need to expand current attempts to include element of rehabilitation and return to work in the treatment process and need to make intervention programs for each phase of industrial accidents care.

If we ask injured workers what they are provided as a rehabilitation program, it is most likely that they will talk about the physical therapy, mainly referring to hot pack therapy. However, rehabilitation medicine only takes care of a part of rehabilitation, and the rehabilitation should include programs in various areas beyond that.

The rehabilitation of injured workers is classified into medical rehabilitation, sociopsychological rehabilitation, vocational rehabilitation, and industrial accident welfare programs. Medical rehabilitation supports the recovery of physical conditions, and includes the recovery in the mental and occupational aspects in a broad sense. Currently, the Labor Welfare Corporation hospital’s specialty rehabilitation center and 101 rehabilitation medical institutions are involved in the medical rehabilitation. Sociopsychological rehabilitation includes psychological support for injured workers, social adaptation program, and family support program. Vocational rehabilitation is a support program such as alternative manpower support program, return to work support program, vocational training support program, and entrepreneurship support program for the purpose of returning to work for industrial accident workers. The industrial accident welfare program refers to the programs to stabilize the life and promote welfare of injured workers and their families. These rehabilitation programs must be comprehensive, and be actually effective, and the benefit rate must be increased.

Social rehabilitation beyond vocational rehabilitation

Furthermore, it is necessary to expand the concept of vocational rehabilitation to the concept of social rehabilitation. This concept can be found in the case of Germany, which provides important implications for expanding the narrow concept of vocational rehabilitation. Social rehabilitation benefits in Germany include followings; ‘benefits for vehicles’, which provide mobility services for injured workers, ‘supplementary payments for residential areas’ supporting workers with disabilities to renovate, repair or move their houses for the treatment, and ‘household assistance and child care expenses’ which are paid to support financial hardship of their households. These social rehabilitation services can enhance the effectiveness of existing programs and help return to work.

For injured workers to recover properly

Let’s summarize. First of all, in order for the rehabilitation program to work properly, it is necessary to prevent occupational accidents concealment so that the size and cause of the actual problems can be revealed. Rehabilitation support should be provided through the services within the system. Second, compensation, treatment, rehabilitation, social rehabilitation, and prevention should be interrelated and intervention for rehabilitation and return to work should start from the beginning of treatment. Third, the concept of comprehensive rehabilitation needs to be established beyond vocational rehabilitation upto social rehabilitation. Currently, various programs are being attempted by the Korea Labor Welfare Corporation, but efforts are needed to make these programs actually work, to increase the number of workers benefited, and to find and resolve obstacles that reduce accessibility.