It has been 22 years of looking at WCB claims that I have watched with dismay as employers have consistently “shot themselves in the foot” for simply not becoming better educated in the process. In particular, there is a real dearth in the understanding of how premiums are calculated, which has led to support and in some cases lobbying, for inappropriate change. The following are four proposed items that if implemented would have an immediate and positive impact on the system:
$1,000 Threshold needs to be updated.
Given that medical costs have continued to increase on an annual basis, the fact that the $1,000 dollar figure has not been updated since originally implemented over a decade ago means that it is much easier to broach the thousand dollar threshold and have this total applied to your experience account. WCB needs to increase this figure to at least $1500. This would have a substantial impact on a number of minor claims.
Medical Form – needs to contain capabilities & restrictions and remove fitness for work aspect.
Removing the section where the doctor states whether or not modified or alternative work can be performed and adding in a section where the Doctor can indicate physical capabilities, would effectively eliminate all questionable temporary total disability (TTD) where a treating physician has stated totally disabled from all forms of employment with a relatively minor injury e.g. cut baby finger.
This change would eliminate the Doctor from becoming a gate keeper which was never their intended role and as outlined by the CMA is not. It would force WCB to do the critical thinking and seek out modified work opportunities. In essence, this one simple change would eliminate a majority of claim processing by WCB and hold them accountable to their mission which is a “focus on return-to-work”.
Medical Service providers that do assessments can’t do the treatment.
Often times WCB will refer an injured worker for an independent medical exam, a fit for work exam or a functional capacity examination. Typically these are done at one of three facilities, Lifemark, Millard and Canadian Back Institute. While all this may be legitimate, what is troublesome is the ability of these facilities to recommend further treatment e.g. occupational rehab, work hardening etc. In essence, they are obtaining a captive referral which they then medically recommend further treatment. The perception is that this may not be in the best interest of the worker but in the best interest of the treating facility as they benefit financially from doing the treatment. To eliminate this situation, the provider that does the assessment should not be allowed to do the treatment. This would make the assessment truly independent and more reliable.
Real Time Decision Making.
Customer service at WCB needs to be provided in real time in order to meet the requirements of both progressive employers and to ensure that delays do not hinder the injured workers recovery. The WCB demand for the Employers report to be submitted within 72 hours of being notified of the accident is too long a time period. Given that this is too long then the WCB goal of adjudication within 14 days of injury and return to work planning within 10 days of acceptance of a claim is completely inappropriate. The goal is for WCB to provide decision making the same day they received the information. It is up to progressive employers to ensure that the WCB receives all the information necessary to make a decision. In this regard, WCB has the capability to make real time decision.
None of the above items requires legislation change and can be made so with the simple stroke of a pen. WCB however is reluctant to make these changes as it fundamentally transforms the way they currently conduct business and puts more accountability on them to fulfill their mandate of providing “strong disability management and modified work programs.” It’s up to industry to educate themselves and lobby for appropriate change that will dramatically improve the system for all stakeholders.