The Board recently released a "Value for Money" Audit (prepared by accounting firm KPMG) of its LMR services. The statistical portrait of the outcome of LMR services in 2007 and 2008 supports the view that the Board is becoming progressively more unrealistic in its expectations of what workers can achieve. The portrait shows that 19.5% fewer workers were found to be unemployable in 2008 than in 2007, but fewer workers were actually working at the end of the plan. Under 50% are actually working at both the 6 month and 18 month point after completion of the plan. With the onset of the deep recession in September, 2008, this decline in employability is what one would expect.
The Audit recommends changes to the legislation, which will have the effect of reducing already low worker benefits. The fairer alternative, of course, is to increase historically low employer assessments.
Tuesday, February 23, 2010
Friday, February 12, 2010
WSIB Narcotic Strategy- Where is the alternative?
The WSIB has introduced a new narcotics strategy, which limits narcotic authorization to short-acting narcotics in the first 12 weeks after injury or recurrence. This strategy does not apply to workers in the Serious Injuries Program or with occupational disease. The attempt to avoid long-term narcotic dependence, while laudable, has not come with a recognition of the need for increased non-narcotic treatment, and in particular alternatives such as physiotherapy, chiropractic, massage therapy and acupuncture.
The WSIB considers these alternatives when rendered after 12 weeks as maintenance treatment. Maintenance treatment is allowed sometimes by the Board, but a concerted effort is usually required to obtain authorization for maintenance treatment. Even more important, the fees paid to these practitioners is usually less than one-half the typical fee, so many do not accept WSIB cases or are reluctant to provide long-term treatment and the concerted effort to obtain authorization for "maintenance treatment" is usually about a small amount of reimbursement. Physiotherapists and acunpuncturists are paid $24 and $38.78 per visit respectively. Massage therapists are paid $50 per visit. Chiropractors are paid $25 per visit, after the initial visit.
There are consequences to the Board's approach to long-term treatment. The inadequate pain control mechanisms lead to increased incidence of depression and other psychological conditions for workers. This does not benefit anyone. Another effect is a tricky one. If a worker suffers a recurrence years after the accident, the Board will look at documented evidence of visits to doctors or other health care practitioners as significant evidence of continuity. Workers often prefer to not see doctors on a regular basis, for any number of good reasons, but the Board's practices results in a powerful incentive for workers to regularly meet with a busy family doctor to discuss ongoing long-term problems. This is an unhealthy situation for both the worker and the family doctor.
The WSIB considers these alternatives when rendered after 12 weeks as maintenance treatment. Maintenance treatment is allowed sometimes by the Board, but a concerted effort is usually required to obtain authorization for maintenance treatment. Even more important, the fees paid to these practitioners is usually less than one-half the typical fee, so many do not accept WSIB cases or are reluctant to provide long-term treatment and the concerted effort to obtain authorization for "maintenance treatment" is usually about a small amount of reimbursement. Physiotherapists and acunpuncturists are paid $24 and $38.78 per visit respectively. Massage therapists are paid $50 per visit. Chiropractors are paid $25 per visit, after the initial visit.
There are consequences to the Board's approach to long-term treatment. The inadequate pain control mechanisms lead to increased incidence of depression and other psychological conditions for workers. This does not benefit anyone. Another effect is a tricky one. If a worker suffers a recurrence years after the accident, the Board will look at documented evidence of visits to doctors or other health care practitioners as significant evidence of continuity. Workers often prefer to not see doctors on a regular basis, for any number of good reasons, but the Board's practices results in a powerful incentive for workers to regularly meet with a busy family doctor to discuss ongoing long-term problems. This is an unhealthy situation for both the worker and the family doctor.
Wednesday, February 10, 2010
Upcoming event
Gary is co-chairing the Law Society of Upper Canada's program Proven Strategies to Enhance Your WSIB Practice, being held at the Donald Lamont Learning Centre at the Law Society of Upper Canada (and simultaneously webcast) on March 4, 2010 from 9:00 a.m. to 12.:30 p.m. This program is designed for paralegals and lawyers with intermediate workers' compensation skills and knowledge. The cost is $210 plus GST and interested persons can register at http://ecom.lsuc.on.ca/cle
Monday, February 8, 2010
Labour Market Re-entry- What it means
The simple answer is "vocational rehabilitation"- steps taken for an injured worker who must change careers as a result of an injury. The simple answer is unfortunately profoundly misleading.
The major impact of labour market re-entry (LMR) decisions is on the long-term benefits of the worker. Workers who must change careers by virtue of an injury do not, on average, return to full-time employment. Most either do not work at all, return to part-time or sporadic employment, or occasionally set up a small business. The WSIB systematically ignores this reality, and attempts to use the LMR process for its justification. As part of this process, the Board attempts to enlist the agreement of the worker.
The way the process works is as follows. The WSIB Case Manager refers the file to a vocational rehabilitation agency with a set of restrictions for the worker. A representative of the agency (unfortunately called an LMR Case Manager) then typically arranges for an assessment of the worker's skills and abilities, with paper and pencil testing. The LMR Case Manager will then propose two "Suitable Employment or Businesses" (SEB), which match the worker's theoretical residual abilities and the requirements of classes of job, and the steps needed to attain these goals. Taken together, these SEB goals and the steps needed to attain them are called an LMR Plan. The LMR Plan is then sent to the WSIB for approval. Once the WSIB makes a decision, the worker has 30 days in which to appeal.
The catch is this. Workers receive full loss of earnings benefits while co-operating in the steps of the LMR plan. Once the plan is over, the WSIB will generally consider that the worker is capable of earning typical wages in full time employment in the SEB and reduce the worker's loss of earnings benefits, regardless whether the worker is actually employed. The higher the typical wages for the SEB, the greater the reduction is.
This means that workers must be especially careful about the viability of proposed labour market re-entry plans, notwithstanding that they may seem enticing, and take prompt steps to record in letters to the WSIB their disagreements with these plans.
The major impact of labour market re-entry (LMR) decisions is on the long-term benefits of the worker. Workers who must change careers by virtue of an injury do not, on average, return to full-time employment. Most either do not work at all, return to part-time or sporadic employment, or occasionally set up a small business. The WSIB systematically ignores this reality, and attempts to use the LMR process for its justification. As part of this process, the Board attempts to enlist the agreement of the worker.
The way the process works is as follows. The WSIB Case Manager refers the file to a vocational rehabilitation agency with a set of restrictions for the worker. A representative of the agency (unfortunately called an LMR Case Manager) then typically arranges for an assessment of the worker's skills and abilities, with paper and pencil testing. The LMR Case Manager will then propose two "Suitable Employment or Businesses" (SEB), which match the worker's theoretical residual abilities and the requirements of classes of job, and the steps needed to attain these goals. Taken together, these SEB goals and the steps needed to attain them are called an LMR Plan. The LMR Plan is then sent to the WSIB for approval. Once the WSIB makes a decision, the worker has 30 days in which to appeal.
The catch is this. Workers receive full loss of earnings benefits while co-operating in the steps of the LMR plan. Once the plan is over, the WSIB will generally consider that the worker is capable of earning typical wages in full time employment in the SEB and reduce the worker's loss of earnings benefits, regardless whether the worker is actually employed. The higher the typical wages for the SEB, the greater the reduction is.
This means that workers must be especially careful about the viability of proposed labour market re-entry plans, notwithstanding that they may seem enticing, and take prompt steps to record in letters to the WSIB their disagreements with these plans.
Monday, February 1, 2010
2010 benefits indexation
The 2010 indexation rate for those receiving full loss of earnings benefits is 0.4%. A worker who received $1,000 bi-weekly in 2009 should receive $1,004 bi-weekly in 2010. Workers who do not receive full loss of earnings benefits will receive a 0.5% increase. The government had made very minimal efforts to compensate for the loss of prior inflation indexing with 2.5% increases in 2007, 2008 and 2009, but these efforts have essentially come to a halt.
For workers not receiving full loss of earnings benefits, the current benefit indexation formula is 1/2 Consumer Price Index (CPI) -1%. So, if the CPI is 4%, these workers receive 1/2 X 4% -1 or 1%. The maximum indexation is 4%. For workers who receive full loss of earnings benefits, benefits are increased by the CPI.
All workers had automatic annual indexation at the rate of CPI prior to 1995. Partial indexation was introduced that year. The current formula came into force in 1998. Even with the 2007-2009 corrections, a worker injured in 1998 has lost 17% to inflation since then.
For workers not receiving full loss of earnings benefits, the current benefit indexation formula is 1/2 Consumer Price Index (CPI) -1%. So, if the CPI is 4%, these workers receive 1/2 X 4% -1 or 1%. The maximum indexation is 4%. For workers who receive full loss of earnings benefits, benefits are increased by the CPI.
All workers had automatic annual indexation at the rate of CPI prior to 1995. Partial indexation was introduced that year. The current formula came into force in 1998. Even with the 2007-2009 corrections, a worker injured in 1998 has lost 17% to inflation since then.
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