Fewer workers getting help for ‘serious injuries,’ statistics show

Critics blame systemic reduction in fair compensation, but WSIB says plunge due to drop in claims.

Thestar.com
July 3, 2016
By Sara Mojtehedzadeh

The number of workers accepted into a serious injury program that dramatically improves their access to medical care has been cut by more than half over the past five years, according to statistics requested by the Star - part of what critics call a systematic reduction in fair compensation for vulnerable Ontario workers.

The Workplace Safety and Insurance Board program provides vital support for employees who are catastrophically hurt on the job, such as full-time care for those who have lost their independence, prosthetics and travel allowances for medical appointments. But the number of people admitted into it has plummeted 57 per cent since 2010 - down from 318 workers to 137 last year.

Critics say the plunge is related to the board’s recent drive to cut workers’ permanent impairment ratings by identifying pre-existing conditions and by often refusing to acknowledge long-term psychological problems. That means that fewer and fewer workers are deemed to be over 60 per cent impaired, the threshold needed to access the board’s Serious Injury Program.

“It’s very, very difficult to get anyone to 60 per cent. Even if you get 59.5 per cent, the board takes the position that you’re not considered seriously disabled, which is ridiculous,” said Airissa Gemma, a community legal worker with Industrial Accident Victims Group of Ontario (IAVGO).

In response to questions from the Star, the WSIB attributed the decrease in the number of workers referred to its Serious Injury Program to an overall decrease in the number of claims filed at the board. In 2010, there were around 238,000 registered claims while in 2015 there were about 229,000, a 4 per cent decline. The board also said there has been a steady reduction in the number of workers with permanent impairments.

In an ongoing investigation into WSIB practices, the Star has previously reported on an apparent shift in culture in how it evaluates permanent impairments - legitimized, critics say, by a 2012 report written by a U.S.-based doctor now embroiled in legal trouble south of the border. A Hawaii-based lawsuit, in which claims have not been proven in court, alleges that doctor helped a private insurance company unfairly slash accident victims’ medical benefits.

The Star also highlighted the case of Fernando Paul, 65, who was left incontinent and bound to a wheelchair after injuring his back in a workplace accident. But his impairment rating was reduced because the WSIB claimed he had degenerative disk disease in a different part of his spine, making him ineligible for the board’s serious injury program. His wife must now care for him full time.

“She has to do everything for me. It’s sad that we have to do this,” he said.

“There’s just simply been greater reluctance to recognize permanent impairments (at the board),” said Michael Green, a lawyer who has worked on behalf of injured workers for 30 years. Between 2012 and 2014, permanent injury awards dropped by 37 per cent, according to WSIB’s own stakeholder reports.

“I’m pretty sure that people who have the objectively very serious physical impairments, people with quadriplegia and so on are still getting into the serious injury program. But they’re narrowing everyone else,” Green said.

In a statement to the Star, the WSIB said that in the vast majority of cases, workers were accepted into the serious injury program before they are assessed for permanent impairments. “Focusing on early medical intervention and active treatment can often restore the worker to their pre-injury level of function and contributes to fewer workers developing permanent impairments due to their injuries,” the statement said.

“We’re saying no, you’re just reducing their awards due to ‘pre-existing conditions,’ ” said John McKinnon of the Injured Workers Consultants. “It looks to us to be part of the general austerity program at the board over the last five years.”

Gemma said she did not know why workers must be deemed as 60 per cent impaired to be eligible for the serious injury program, a figure she calls “arbitrary.”

“Fifty-nine per cent is just as disabled as 60 per cent. . . I really don’t understand the 60 number. Your guess is as good as mine,” she told the Star.

As for the board’s contention that fewer workers in the province are sustaining permanent injuries, Gemma says her organization has seen no evidence of it - her legal clinic is still overwhelmed by the number of injured workers seeking help.

“I’ll be very simple. To me, that’s a lie.”