Claims derailed

Workers' Compensation decisions skewed by incentives, deadlines, critics say

A bonus system that rewards case managers for saving money and clearing cases by deadlines has skewed the decisions of the Workers' Compensation Board against injured workers, say both their advocates and former board staff.

But the board says its internal "goal-sharing" program merely leads to claimants getting back to work more quickly.

Internal WCB documents obtained by the Sun show staff teams being praised for clearing away specific ongoing injured workers' files by specific deadlines.

Its critics argue this introduces an artificial time constraint, leading to claims being rejected or workers being returned to the workforce.

"If a team meets its objectives, however those are statistically defined, it receives its bonus," said a former staff member, one of several who requested anonymity for fear of repercussions.

"And they weren't telling you that you had to shut down a file. They were just saying they wanted a certain number gone by a certain time, and if that happened, the team would get a bonus.''

Said another former staff member: "The system requires you to look at a person, look at a claim and try to resolve it fairly, without being adversarial. But when you're always working against the clock and following statistical targets, that's hard to do. So it wasn't encouraged. In fact, if anything it was probably discouraged."

Anyone who questioned such practices usually lost their job shortly thereafter, said the former staffer.

The board confirmed it has internal bonuses but the intent is to get workers back on the job as quickly as possible, thus reducing the chance of a temporary disability becoming permanent, said spokesman Jacqueline Varga. "We do not reward case managers for inappropriately closing claims,'' she added.

"The Journal of Workers' Compensation confirms that the longer a worker is off the job, the tougher it is for him to return successfully.

"We believe that, and work hard to help injured workers regain their independence. Our goal-sharing program reflects this commitment."

Local workers' advocate Theresa Roper couldn't understand why some of her clients had been forced to go back to work despite obviously debilitating injuries, until she found out about the "goal-sharing" program.

"Sometimes the only way a team can meet its targets is to close a file or find the individual fit to go back to work," she says.

"But that's a lot of pressure to put on someone: either you solve these difficult cases, or you cause your co-workers to be put out as well. So their reason for ending a file ends up being pretty much any reason they can find to end it, and as quickly as possible."