Costs cut at workers’ expense: report
Study says thousands of injured employees are affected each year
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, 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 was initiated in 2010. It 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 among injured workers. It also says the falling price of drugs and a boardwide 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 ombudsperson 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, “Bad Medicine: a report on the WSIB’s transformation of its health care spending,” claims the organization cut prescription drug spending by one-third between 2010 and 2015, and reduced the number of claimants it provides drug benefits to; in 2010, 38 per cent of claimants were allowed 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,” the report 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 perclaim 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 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 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. Doctors also get paid more to tell the board a worker with a musculoskeletal injury is ready to go back to work. However, doctors receive 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,” Singleton said.
“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.”