Response to phase I of the WSIB’s consultation on the Independent Living policy suite, following the value-for-money audit of the Serious Injuries Program. In addition to feedback on the specific consultation questions, the submission highlights the negative consequences suffered by many injured workers with serious injuries resulting in a permanent impairment, the need for a wholesale rethink of WSIB policy and practice to avoid many of those long-term consequences, and address the barriers to a full or substantial recovery.
Thunder Bay & District Injured Workers Support Group
1201 Jasper Drive, Unit “C”
Thunder Bay, ON P7B 6R2
tbiwsg@gmail.com
October 13, 2022
WSIB Consultation Secretariat
consultation_secretariat@wsib.on.ca
Greetings,
Thank you for the opportunity to share some thoughts on this important consultation.
I lost my left arm in an industrial accident in 1978 and have been active ever since studying the workers compensation system and how it effects injured and disabled workers and how it can be improved.
I have seen the system from a variety standpoints. As an employer – owner operator of a small construction company for 10 years after my injury. As a peer helper with the Thunder Bay & District Injured Workers Support Group (TBDIWSG) since 1984. As the manager of vocational rehabilitation services with the Ontario March of Dimes in Thunder Bay. As a member of the Board of Directors of the Ontario Workers Compensation Board of Directors. As the co-lead on the 7-year community – university partnership – the Research Action Alliance on the Consequences of Work Injury. And presently as the chair of the Research Action Committee of the Ontario Network of Injured Workers Groups (ONIWG).
Over these many years, it has become clear that many injured workers with serious injuries resulting in a permanent impairment (that is they have a NEL or PD rating) continue to suffer the negative consequences of their injury or disease. This includes chronic unemployment, poverty, depression and other mental illnesses, ongoing pain, and family breakdown.
Research has consistently shown that nearly 50% of workers with a NEL or PD experience these negative consequences. Clearly our public system can do better.
The idea that only the most severely injured workers (those with a 60% NEL or 100% PD) need special help available thought the serious injury programs is flawed.
We need a wholesale rethink of WSIB policy & practice to avoid many of these long-term negative consequences.
There are many barriers in the present policy & practice that workers face that impede a full or substantial recovery. These include:
- The bias included in the AMA guides. A massive research project was undertaken by the Ontario WCB in 1990-1992 where 11,000 injured workers with a permanent disability/impairment were surveyed. One aspect of the research was to develop a new rating schedule to be used in the new wage loss system starting in 1990. The results clearly showed that both the old WCB schedule and the AMA guides did not reflect the lived experience of these workers with a disability.
By under rating the level of impairment/disability, the system ends up blaming many injured workers for their individual hardships. And as a result, programs and services that could mitigate these hardships are not made available to the workers that need helpHaving a super high threshold of a 60% NEL (or 100% PD) to be eligible for the serious injury program means that only 1 % of workers with a NEL will qualify – when thousands more need this help every year. - Having a super high threshold of a 60% NEL (or 100% PD) to be eligible for the serious injury program means that only 1 % of workers with a NEL will qualify – when thousands more need this help every year.
Making things worse is that there is a stigma attached to many workers who don’t heal within the proscribed timelines or don’t return to work quickly. I reference the recent research funded by the WSIB and done at the Institute for Work and Health. One article from the study titled The Association Between Case Manager Interactions and Serious Mental Illness Following a Physical Workplace Injury or Illness: A Cross‐Sectional Analysis of Workers’ Compensation Claimants in Ontario (paper attached) found that over 15% of workers with a lost time claim developed a mental illness because of how they were treated by their case manager at the WSIB. Most of these workers will not even qualify for a NEL let alone get a 60% rating. - The present focus on reducing system costs and the initial return to work. This focus often ignores the actual circumstances of the injured worker which is contrary to good rehabilitation practices. The policy & practices at the WSIB seem to expect individual workers to conform to the “norm” established by policy – rather than addressing where the worker’s recovery is in the present tense.
We encourage the WSIB to engage with us in a more concerted effort to reduce barriers to recovery and improve the health, wellness, employment, and financial security outcomes for injured and disabled workers. Such discussions could lead to re – building lives and communities that can benefit us all.
We will address some of the questions you posed but overall want to endorse the submission made by Lois Cromarty from the Northumberland Community Legal Clinic (submission attached).
We would be pleased to share more research findings and engage with you to explore options to make improvements to the lives of thousands of injured workers, their families, and communities.
Also attached is our Platform for Change document for a more fulsome analysis of our hopes for the future of the system.
Sincerely,
Steve Mantis
Treasurer
TBDIWSG
Chair
Research Action Committee
ONIWG
WSIB Serious Injury Program Value-for-Money Audit
Review of the Independent Living policy suite
Phase 1 Consultation, Fall 2022
1. Does the severely impaired threshold continue to be a suitable criterion for considering entitlement to the benefits and services in the independent living policy suite?
No. Research clearly shows that the present system does not acknowledge the lived experience of thousands of workers with a work acquired disability every year.
We suggest a 30% NEL (rather than the present 60% NEL) would trigger entitlements as a starting point. Policy should be generous in its direction to decision makers to address the needs of individuals regardless of the existence of a NEL rating.
2. Is someone’s permanent impairment rating or expected permanent impairment rating a reliable indicator of the scope and duration of the benefits and services they are likely to need as a result of the work-related injury or illness?
No.
3. Does the severely impaired threshold result in people with serious injuries receiving the benefits and services they need as a result of the work-related injury or illness?
Some few workers receive some of the benefits and services they need but leave thousands of workers without support
4. Identifying entitlement criteria for benefits and services supports consistent and predictable decision-making. Aside from the NEL and PD rating, are there other criteria or measures that would better indicate whether someone might need a particular benefit or service? For example, lack of independence with activities of daily living (ADLs), independence with instrumental activities of daily living (I-ADLs), combination of diagnosis and function, standardized tests or assessments.
We must question the value of “consistent and predictable decision-making”. Is this more important that quality decision making that addresses the actual needs of actual people? We think not.
5. Many of the benefits and services in the independent living policy suite contemplate long-term, permanent needs. Are there circumstances in which it would be beneficial to provide any of these benefits or services on a short-term or temporary basis?
Yes.
6. Immediately following a work-related injury or illness, treatment and recovery are the primary focus.
a) At what point in a person’s recovery should benefits and services to facilitate independent living be considered? Are there specific factors or indicators that should be considered?
Benefits and services should be provided whenever they are needed.
For example, when my arm got torn off at work in 1978, I was a single man living alone. My treating doctor would not release me from hospital without having a support person in place. This was o=not offered or provided for by the WCB.
b) At what point in a person’s recovery should benefits and services to improve quality of life be considered? Are there specific factors or indicators that should be considered?
The sooner the better. The more support a worker receives in the early stages of recovery can be a key determining factor in long term outcomes.
7. Are there benefits and services that should be provided immediately and reviewed as the injured person’s needs change?
Yes
8. Are there benefits and services that should be provided only once it is clear what the injured person’s long-term needs are/likely are?
No. See #6 (b) above.
9. Do universal benefit amounts (e.g., flat rate for the independent living allowance) continue to be appropriate for meeting the needs of people with serious injuries?
No. The flat rate could be a minimum amount with discretion to determine individual circumstances.
10. Aside from the severely impaired threshold, do the other entitlement criteria in each of the individual policies in the independent living policy suite allow for the provision of benefits and services that align to the needs of those with severe/significant injuries?
The entire policy suite should be reviewed with a view to the needs of injured workers with compensable psychological impairments
Download Thunder Bay & DIWSG Submission to the WSIB Serious Injury Program consultation