Social Policy in Ontario

Ontario’s worker compensation board is saving money by reducing spending on drug benefits for workplace accident victims and by providing financial incentives to their health-care providers to limit treatment time, a new report compiled by a Toronto-based legal clinic says.

The study released Wednesday, which is based on a series of freedom of information requests to the Workplace Safety and Insurance Board, says there has been “a significant cut in prescription drug benefits that affects thousands of injured workers per year” since a cost-cutting drive initiated at the board in 2010. It also found a shift toward “services that are structured to drive down the cost of benefits paid to injured workers.”

“For injured workers, the WSIB’s historic ‘transformation’ has resulted in substantial, harmful cuts to health-care benefits,” says the report, which was conducted by the Industrial Accident Victims Group of Ontario (IAVGO) and Toronto lawyer and worker compensation specialist Antony Singleton.

“Injured workers need to be able to trust WSIB to provide the health care they need, but this report shows that the WSIB is abusing that trust and unfairly reducing claims costs at the expense of workers’ health,” said Jessica Ponting, a community legal worker with IAVGO.

Since 2010, the WSIB has sought to reduce its $14 billion unfunded liability, but maintains that health outcomes are improving amongst injured workers. When it comes to health benefits, it says the falling price of drugs and a board-wide strategy to limit the prescription of harmful narcotics has saved money.

WSIB has responded to past criticisms of its health services, including a formal complaint to Ontario’s ombudsman by injured worker advocates, by saying it has “confidence in the integrity of Ontario’s health-care professionals” and that it “acts quickly to ensure workers receive timely, specialized medical care.”

The IAVGO study, entitled “Bad Medicine: a report on the WSIB’s transformation of its healthcare spending,” claims the organization slashed spending on prescription drugs by one-third between 2010 and 2015, and reduced the number of claimants it provides drug benefits to; in 2010, 38 per cent of successful claimants were allowed drug benefits but by 2015, the figure was 27 per cent.

“This reduction has exceeded the decline in the total number of allowed claims entering the system,” the report says.

“As things currently stand, some 18,000 injured workers per year have disappeared from the drug benefits program, with no viable explanation from the WSIB,” it adds.

The report claims statistics do not corroborate the WSIB’s contention that cheaper drug prices have resulted in efficiencies. That is because the overall reduction in the board’s drug spending has far outpaced the decline in average drug costs per individual claimant. The report also says the board’s data shows its narcotics strategy has had “no discernible effect on either the incidence or per-claim cost of narcotic drugs, and therefore does not explain the reduction in drug benefit spending.”

The board’s health-care programs for injured workers also provide financial incentives for health professionals to limit treatment by incorporating “cost-control measures” in their structure, the report argues.

The WSIB’s “programs of care” for different types of common workplace injuries are supposed to “integrate recovery and return to work planning.” In examining programs for musculoskeletal injuries — one of the most pervasive and costly types of worker compensation claims — the report found that treatment is capped by the board at eight weeks, regardless of the worker’s expected recovery time or individual circumstances. Further treatment is only made available if a WSIB adjudicator allows it.

In some eight-week programs, the report says, physicians get a declining rate of pay the longer the treatment. For example, for lower back and musculoskeletal, practitioners get paid a flat fee of $400 per treatment in the first month, but that fee is slashed in half for treatments in the second month of recovery.

Doctors also get paid more to tell the board that a worker with a musculoskeletal injury is ready to go back to work. When filling in mandatory treatment outcome forms, doctors are paid $600 if they deem the worker fit to return to regular duties. But they are paid up to 33 per cent less, between $400 and $500, if they advise that the worker cannot return to their pre-injury job.

The result, argues the report, is a structure that “puts the health-care provider’s financial interests in conflict with the interests of the worker, who may need additional treatment and time to recover from her injury.”

The WSIB says 92 per cent of injured workers now return to work with no wage loss, and that permanent impairments as a result of workplace accidents are on the decline. But the report says those statistics reflect the board’s more restrictive decision making in allowing compensation claims.

“The WSIB has, for years, misused its data to mask significant cuts to benefits. This report pulls away the mask to reveal the true face of the WSIB’s austerity measures,” said Singleton.

“The WSIB’s permanent impairment data do not give a direct, independent measure of the actual health outcomes of injured workers. They instead record the WSIB’s adjudicative decisions about entitlement to benefits,” the report says.

“For injured workers, then, the supposed benefits of the (WSIB’s) transformation are an illusion, so no one feels them,” it concludes. “The cuts, by contrast, hurt because they are all too real.”

https://www.thestar.com/news/gta/2017/05/24/wsib-cutting-costs-at-expense-of-workers-health-report-says.html