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Summer-Fall 2005

Allegations of fraud

A former Alberta WCB Case Manager made some very serious allegations of fraud against the WCB in an article from the Edmonton Journal – Sept. 11/99

Pressure on at WCB, ex-staffer says \ Case managers encouraged to denyclaims, cut payouts to injured workers.

Case managers at the provincial Worker’s Compensation Board are pressured by their supervisors to deny claims or reduce payouts to injured workers as a cost-saving measure, claims a former WCB employee.

The WCB looks for ways to save money by minimizing the income-support payment s injured workers receive, and by reducing their permanent disability awards, says former case manager Kevin Becker.

“It’s done in a very convert ways,” said Becker, who worked for the WCB from 1991 to 1997.

“You (the case manager) put in an earning loss claim for a worker, and your manager will come back and say “No, we can save money if we say the employee is capable of doing some work, when we know he’s not.”

“Or you are told to tell the injured worker he had a pre-existing condition, like arthritis in his back and he isn’t eligible for disability payments. It’s that kind of thing.” He said the WCB’s prime strategy seems to be a war of attrition – “keep denying and the worker will give up.

” Becker, who has a consulting firm and also is an advocate for injured workers having trouble getting WCB payments, said the practices appear to be the same today as they were when he left two years ago. “The focus is on liability – how much liability are case managers able to clear away to protect the WCB fund,” he said.

But a WCB official denied Becker’s claims, saying the board’s primary focus is on customer satisfaction, both for employers and for injured workers.

Becker’s comments come as Human Resources Minister Clint Dunford is deciding whether to investigate a number of complaints against the WCB by injured workers. Becker didn’t blame individual case managers or supervisors. Instead, he blamed a corporate culture which he says pays more attention to the bottom line than to injured workers. “They have lost sight of what they’re supposed to be, which is protection for the worker,” he said.

Employees who save the WCB the most money tend to get promoted while those who are deemed to be too generous to injured workers are often forced out of their jobs, he added. “The system generates a lot of statistics on which case managers are costing the most,” he said. “Those who are, tend to get ridden a lot harder by supervisors. There’s a lot of constructive dismissal.”

But a WCB official disputed his allegations. “At no time has there been any motive for case managers to deny benefits,” said Nancy Saul-Demers, director of corporate communications for the WCB. She said staff members are paid bonuses based on worker and employer satisfaction, not on the amount of money the WCB saves. “Any bonuses they receive are tied to corporate objective that revolve around customer satisfaction,” she said. “The motivation is to ensure that workers are satisfied. We wouldn’t try to do that by reducing benefits.”

WCB payouts for income support, medical costs and rehabilitation have been increasing yearly, which She cited as proof the WCB isn’t slashing benefits to save money. The average cost per claim has r8isen to $9,200 this year from $8,500 in 1997.

But Becker said he noticed a shift in attitude in 1993 and 1994, as the WCB attacked its mounting deficit.

“They started digging up old claims,” he said. “We were told to take a look at old earning losses and to see if we could reduce it. We were phoning up workers who had received entitlements for years, and saying we’ve just reviewed it, and decided that you’re capable of earning more, and next week your cheque will be less.”

He left in 1997 to do human resources consulting work for the David Thompson Health Authority. He also turned his WCB experience into a career in workers’ advocacy.

:”It’s my impression the WCB has become much worse since I left,” he said.

From the Canadian Injured Workers Alliance newsletter:

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