Doctors feel sidelined by WSIB; ‘Opaque and confusing’ system frustrates physicians, report finds

This story appeared in the Toronto Star on January 9th. 

written by Sara Mojtehedzadeh.  Sara has been a determined truth teller when it comes to Injured Workers in Ontario and Canada.  All her articles are well worth reading.  At a time when the press is under attack.  I want to take a moment to thank Sara for her dedication to tell the little persons story…. and the Toronto Star for publishing the articles she writes

They are the first port of call for workers hurt on the job. But when decisions are made about accident victims with complex injuries, a new study suggests doctors feel sidelined by workers’ compensation boards. The report, conducted by the independent, Toronto-based Institute for Work and Health (IWH), examined the role of doctors and other health-care professionals in workers’ compensation across four provinces, including Ontario. It found doctors treating workers with complicated or prolonged conditions were frustrated by an “opaque and confusing” system where their views on a safe return to work after an accident appeared to sometimes be ignored by case managers with no medical training.

 It quickly became clear that there was a significant amount of disagreement and confusion about what the role of health-care providers should be in the return-to-work process and in the workers’ compensation system more generally,” the report concluded.

 Agnieszka Kosny, a scientist with the IWH who led the study, said doctors rarely reported encountering significant problems when their patients had visible, acute physical injuries. But that changed when workers had multiple injuries, chronic pain and mental-health conditions.

 In those cases, health-care professionals expressed concern that compensation boards’ return-to-work programs “might not be appropriate and could do more harm than good” and were sometimes motivated by “cost-containment” rather than the best interests of patients.

 “Sometimes where things go off the rail is when a decision is made, and the health-care provider feels like they have been excluded from that process. I think that further alienates them from the process,” Kosny said.

 In a statement to the Star, Workplace Safety and Insurance Board (WSIB) spokesperson Christine Arnott said the board “values its relationships with health-care providers” and said the study “confirms the importance” of its return-to-work programs.

 “There are valuable findings in the report with respect to improving engagement with health-care providers,” Arnott said. Board staff will meet with the report authors to discuss the study this month, she said.

 Critics say the findings bolster a formal complaint made to Ontario’s ombudsman a year ago by labour groups, doctors and injured-worker advocates asking the watchdog to investigate the WSIB for ignoring medical opinions provided by physicians treating workers, resulting in accident victims being unfairly cut off benefits or pushed back to work too early.

 “This is not something that’s new. It’s something that we have brought to the attention of the government as well as the compensation board,” said Karl Crevar, who has been an activist in Ontario for more than two decades, ever since he hurt his back on the job in 1987.

 “This is another piece of evidence to say there is a systemic problem,” added Aidan Macdonald of the Toronto-based legal clinic Injured Worker Consultants.

 “Somebody needs to take it seriously and somebody needs to do something about it.”

The ombudsman has yet to make a decision on whether it will launch a probe.

In a statement to the Star, the ombudsman said its assessment of the issue was “ongoing” and that it was “monitoring ongoing dialogue” between the WSIB and complainants.

The latest IWH study is based on interviews with close to a hundred doctors in British Columbia, Manitoba, Ontario and Newfoundland and Labrador. Researchers also interviewed 34 compensation case managers, although the WSIB declined to participate in the study because it was “in midst of changes to its service delivery model,” according to the board. Researchers spoke to case managers employed by private companies to deal with WSIB claims instead.

Doctors in the study expressed dissatisfaction with dealing with case managers with “limited medical knowledge.” One Ontario health-care provider described treating an injured worker with a neck, or cervical spine, injury whose benefits were almost denied because of confusion over basic anatomy.

“For some reason, (the WSIB) had requested records, and there was something in the patient’s chart about cervical dysplasia, like of your cervix, the female genital organ. They said she wasn’t covered because she had a pre-existing condition, which is completely ridiculous,” the doctor said.

Compensation case managers told researchers they often had difficulty getting information from health-care providers treating injured workers, resulting in a “heavy reliance” on the advice of so-called independent medical consultants who review workers’ medical files, but often never meet the patient.

The report found a number of doctors treating injured workers were concerned such consultants “were not independent” and that their medical opinions were “problematic.”

 “Some health-care providers believed that case managers may cherry pick opinions offered by internal consultants, choosing those that were favourable to the workers’ compensation board (for example, ones that reduced costs),” the study said.

Kosny said she saw a role for independent medical consultants in the compensation system, especially if injured workers did not have a regular doctor or were seen by emergency room staff. But she said provinces such as Ontario could consider adopting a system like Manitoba’s, where such consultants actually examine patients in person.

 She said family doctors offered valuable assessments of accident victims because they had better overall knowledge of their health, adding that treating physicians needed more support from compensation boards to play an active role in decisions about benefits and return-to-work programs.

 “There just doesn’t seem to be a lot of resources that are specifically directed at health-care providers,” she said.

In the meantime, Crevar said, workers are falling through the cracks.

“We have injured workers in dire straights, on the verge of family breakdown or even committing suicide because they don’t know what to do,” he said. “And we are seeing more and more of that throughout the province.”

 

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