July 11, 2017 By: Peggy King
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Injured workers rely on the Workplace Safety and Insurance Board (WSIB) to look after their health care and coordinate compensation. In the past, the Board has been criticized for focussing on finances, rather than the health and welfare of workers. A report released in May by the Industrial Accident Victim’s Group (IAVGO) titled Bad Medicine: A Report on the WSIB’s Transformation of its Health Care Spending appears to support some of these criticisms.

Work injury report

What does the report say?

This report outlines how the WSIB provides healthcare programs for injured workers, but also offers financial incentives to health professionals to limit treatment by integrating cost-control measures into their structure. The WSIB has programs of care for different types of workplace injuries, and the supposed goal is to integrate recovery and return-to-work planning.

IAVGO states in the report that one of the most common (and most costly) programs is for musculoskeletal injuries. It is suggested that this treatment is capped by the Board at 8 weeks, regardless of recovery times or individual circumstances, unless a case manager allows an extension. It is also suggested that in some of the programs the clinicians receive a declining rate of remuneration the longer the worker is involved in treatment.

In addition, it’s alleged the doctors are paid more to tell the Board that a worker is ready to resume regular duties, compared to if they confirm that they are not fit to return to their pre-accident work. Obviously, this would seem to be a conflict of interest and puts at risk the injured worker’s ability to recover and seek additional treatment.

Advice for injured workers

For some workers, obtaining quick access to a Board-supported program will be a benefit to them, especially if they are in a position where they do not have a family physician that is able to make a referral for proper investigation and treatment.

Other workers with pre-existing conditions or underlying asymptomatic conditions, that they may not have been aware of prior to the injury, may have a different experience and find their benefits are terminated earlier, or before they can physically return to work.

For this reason, it is imperative to ensure that you consult with your family physician from the date of the injury. You should also request that additional referrals for tests or to specialists occur when you are not in agreement with the information provided by the clinicians retained by the WSIB.

If you do not have a family physician, it is advisable to seek medical attention regularly through the same walk-in clinic, as this will allow them to build a file regarding your condition post-accident. It is imperative to keep your personal medical team involved in your care. Any disagreement as to your diagnosis or recovery will ultimately affect your entitlement to further health care and Loss of Earnings (LOE) benefits, as well as any decisions regarding fitness to return to work.

Please remember, however, that the WSIB will only pay for treatment that they approve and this must be done prior to commencing treatment with a new provider.

For more information about the WSIB and receiving treatment for workplace injuries, contact our Personal Injury Group.

This content is not intended to provide legal advice or opinion as neither can be given without reference to specific events and situations. © 2017 Nelligan O’Brien Payne LLP.