“WSIB ‘paper doctors’ – Not a systemic problem? Hang on a minute” / Ron Ellis (Administrative justice system reform, Jul. 29, 2016)
Ron Ellis, one of Canada’s foremost authorities in workers’ compensation law and former Chair of Ontario’s Workers’ Compensation Appeals Tribunal, has delivered a detailed critique of the WSIB’s response (see Toronto Star, Jul. 10) to the OFL / ONIWG report “Prescription Over-ruled”. Following charges by injured workers, advocates and physicians contained in that report and a subsequent “Submission to the Ombudsman” that the Board systematically ignores the advice of workers’ treating doctors “for the purpose of rejecting and limiting otherwise legitimate injury claims”, the WSIB has released findings from its recently conducted internal review (WSIB Analysis of the Utilization of Medical Consultant File Reviews)
At the time of its release, the scope of the WSIB internal investigation, which looked at a random sample of 376 cases from 12,000 in 2014, was greeted with disappointment and scepticism: “The WSIB has unfortunately chosen to investigate only one symptom of a much broader problem, and is now attempting to use the results of its narrow investigation to discredit the system-wide critique…The WSIB document appears to be a deliberate attempt to deflect the conversation…” (David Newberry, Injured Workers’ Consultants)
Good enough. Really?
In his article, Ellis notes the WSIB seems satisfied that in “just 15%” of the cases examined did the WSIB’s medical consultants disagree with the opinion of the workers’ treating doctors, and in “only 8%” of the review cases did the decision-makers fail to take “into account” the evidence of the worker’s own health care providers (none of the 40 cases cited in the OFL/ONIWG reports was included in the sample cases).
Yet, as he points out, in that 12-month period:
- 960 injured workers had their medical issues decided on the basis of the medical consultants’ opinions without having the evidence of their own health care providers taken into account
- another 1,800 had their medical issues decided in the circumstances where the Board’s medical consultants disagreed with the evidence of the workers’ own health care providers
But the Internal Review report fails to mention the outcome in these approx. 3,000 cases (23% of the total)? Were they decided for or against the injured worker? Did the decision-makers weigh all the evidence (and conflicting) evidence objectively?
A significant sample?
It is generally agreed that almost 95% of cases of occupational injury – the overwhelming majority – are straight forward, medically uncontentious and the worker able to return to work within the expected time.
For the Board’s study to have been meaningful, the sample of cases reviewed should have been selected from that smaller cohort of cases involving medical consultants in claims regarding serious injury or permanent impairment (and where cost implications were of concern to the Board).