Evidence of meeting #52 for Veterans Affairs in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was worker.
A recording is available from Parliament.
3:40 p.m.
Liberal
The Chair Liberal Neil Ellis
I'll call the meeting to order.
Pursuant to Standing Order 108(2) and the motion adopted on February 6, 2017, the committee is resuming its comparative study of services to veterans in other jurisdictions.
In the first hour, from the Workplace Safety and Insurance Board (Ontario), we have John Genise, the executive director, case management. We'll start with 10 minutes and then swing into questions.
We'll turn the floor over to Mr. Genise.
3:40 p.m.
John Genise Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Thank you, Mr. Chair, and members of the standing committee.
Thank you very much for giving me the opportunity to speak to you here today. It's something I don't often get to do in my normal duties.
As you said, my name is John Genise. I'm an executive director on case management at the Workplace Safety and Insurance Board and I also reside in Ottawa.
I'll give you a little bit about the WSIB. We're one of the largest organizations of its kind in North America. We provide workplace insurance for more than five million workers and over 300,000 employers across Ontario. Each year we receive an average of 230,000 claims. We collect over $4.5 billion in employer premiums to fund the system and no tax dollars are involved. Relevant to this committee, we registered approximately 3,800 traumatic mental stress claims in 2016 and we are actively managing about 1,300 of those.
In terms of the criteria for entrance into our policies, there are a few. If a designated worker, who is typically a first responder, is diagnosed with post-traumatic stress disorder and meets specific employment criteria, it is presumed to have arisen out of and in the course of their employment, unless the contrary is shown. So we have a presumption clause.
All other workers are entitled to benefits for traumatic mental stress when they experience an acute reaction to a sudden or unexpected traumatic event arising in the course of their employment. A traumatic event may be the result of a criminal act, harassment, or a horrific accident. In all cases, the event must be clearly and precisely identifiable, objectively traumatic, and unexpected in the normal or daily course of the worker's employment or the work environment. The policy considers acute reaction, cumulative effects, and harassment as three types. Now, I'll tell you a little bit about us.
In terms of this committee's areas of interest, I'll speak a little bit about compensation for pain and suffering. The WSIB insurance replaces lost wages, covers health care costs, and helps workers get back to the job safely. We do not financially compensate for pain and suffering. We do have a non-economic loss award, or benefit, for a functional abnormality or loss which results from the injury. It's expressed as a “whole person impairment” as a percentage using a prescribed rating schedule—we use the AMA guide. In 2017, that prescribed amount, the “whole person” base amount, was approximately $59,000. The base amount is then adjusted at the time of the injury, based on the workers age. There's an added adjustment factor for every year that the worker is under the age of 45 and on the other side, we subtract the same adjustment factor for every year that they are over the age of 45.
In terms of short and long-term income replacement, the WSIB pays for loss of earnings, both full or partial, starting with the first day after a work-related injury. Benefits are calculated depending on the date of injury, based on annual wage ceiling. We pay 85% of net average earnings. Loss of earnings benefits continue until the person is no longer impaired by the injury, there's no longer a loss of earnings—perhaps they're back to work—or until age 65, whichever comes first. After 72 months, those benefits are made permanent to age 65. Payments are issued every two weeks and adjusted for inflation annually.
In terms of supplementary support for severely injured veterans—one of your interest areas—our approach is recovery first, access to quality medical care, layered with support for a return to work when appropriate. Workers must have a DSM diagnosis to qualify and we often fund this assessment, even prior to accepting a claim. Often workers don't have the means to get assessed in order to reach the entrance criteria, so we'll pay for that, even if we don't have an allowable claim. Our approach to managing these files is that we have a multidisciplinary team. We have dedicated case managers for these cases, as well as dedicated nurses. We also have dedicated work reintegration specialists and they are in the worker's own community. We also have contracted medical services. We have a dedicated roster of psychiatrists and psychologists across the province in order to expedite care for these clients. We also use the Centre for Addiction and Mental Health, CAMH, for assessment and treatment.
In terms of transition and rehabilitation services, I said earlier that a provider network has been established to assist and provide clinical expert assessment and recommendations to workers in communities across Ontario. This means that we move quickly to get workers treated when needed. For us, return to work is our primary focus. We want to make sure that we restore workers' abilities before we can move forward on these cases.
Work transition specialists are involved early in post-traumatic stress claims, even before the worker is ready to work. We use a collaborative approach in return to work planning, by involving the client, the employer, and the treating physician together to come up with a plan. When workers are able to go back to the workforce, we continue to support them while they are working, and help them to work through their challenges and some of their barriers.
That primarily is my presentation on the four areas that you wanted us to focus on.
I'd be happy to take any of your questions.
3:45 p.m.
Liberal
3:45 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Thank you, Mr. Chair.
Thank you, Mr. Genise, for being with us today.
As you're aware, at this point we're basically studying comparatively veterans issues in other jurisdictions. Having you here provides an idea of another jurisdiction, not necessarily in another country, but in another jurisdiction that provides services and how you deal with that aspect of it.
I come from Saskatchewan. As a chiropractor there, I have dealt with WCB in Saskatchewan. I'm not familiar with WSIB. I realize that every province has different WCB issues and ways to handle them.
One of the main things they talk about is getting back to pre-accident status. That is the big issue. You touched on it a bit when you talked about return to work and assisting workers in that.
I wonder if you could expand a little more on where you see that role, and maybe you might surmise how you might see that with the veteran population as well.
3:50 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Our main focus at the WSIB, and I think all across the province, is return to work. However, these cases are particularly challenging because of their nature, so we try to build a strong platform medically to make sure we're going into charted waters. As I said earlier, it is collaborative. We take a slower approach with these than with someone who has a strain, for example because these cases require more care.
We have a number of programs, but primarily it is a slow reintegration into the workforce, and a planned effort. We support our clients with a multidisciplinary team, so there is nursing available for them to work through their medical challenges. We typically have boots on the ground in terms of reintegration with the accident employer. We'll have someone, face to face, do planning with the worker and involve the physician, so together they're working towards employment.
You mentioned the return to pre-accident employment and function. That is the ultimate goal, but we start very slowly and incrementally, particularly on these cases. They are more challenging, and we want to maybe guarantee success by going slow and having a thoughtful plan.
If we can get a worker back to work one day a week or two hours a day, depending upon what the medical needs are, we'll do that, because when workers are outside their normal work environment, they are outside their social environment, their safety net, so to speak. Even integrating them to the workforce in a slow capacity, in any capacity, reaffirms their position in the employment relationship with their peers, with their supervisors. Going slow, oftentimes we find is the way to go.
3:50 p.m.
Conservative
Robert Gordon Kitchen Conservative Souris—Moose Mountain, SK
Often we've heard throughout our studies that issues of stigma are a big concern in how our veterans are dealing with that transition. Whether it be mental illness, PTSD, or physical injury, whatever capacity it may be, it's the issue of whether that soldier is able to deploy. That's the main focus.
When I have dealt with that as a practitioner, I have often seen people fall through the cracks: Who is taking charge of this? Who is the boss? Is it the MD, the chiropractor, the physical therapist, the nurse? How do you manage to make certain that isn't going to be detrimental to your clients?
3:50 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Our quarterback, per se, is the case manager. They coordinate all that happens at the workplace, as well as medically. They are the point of contact for the challenges and barriers that exist and how to work through them.
Because we have work transition specialists going to the employment site, they do a collaborative plan with the frontline supervisor and the employee, whatever medical staff the employer would bring, and the union, and they put together a plan. Everyone signs off on that plan so that the expectations for what is to follow are clear to everyone, and therefore so is the accountability.
We do deal with stigma. I'm sure it's not quite the same, but there are probably some common threads in how we handle that. We make the employer accountable for their workplace and for their work culture, and if it's not a good plan for any reason, we won't put someone in harm's way until we're satisfied they are going to be treated with the dignity and respect they are required to receive according to the law of the land. We have the Ministry of Labour to protect that. The accountability is on the employer because that's their workplace, that's their culture. We would hope that frontline supervisors and and their superiors would be supportive of a gradual return to work.
On our system for employers, there is a financial benefit for them in returning someone to work quickly. It's an insurance system, so the longer we pay benefits, the more expensive it is for the employer the longer the worker is off work. There is a financial incentive for employers to make it a good plan, because if it fails, we're going to take the worker out of the work environment and perhaps start over again with them or with another employer, which becomes even more expensive in terms of the insurance model.
3:55 p.m.
Liberal
Colin Fraser Liberal West Nova, NS
Thank you very much for being here today and for your presentation.
I'm from Nova Scotia where we call it the Workers' Compensation Board of Nova Scotia, but I understand that it's different here in Ontario as it is in other provinces. With regard to the compensation benefits that are paid, can you explain what exactly the economics look like for the worker? Are they getting their full salary? What percentage of their pre-injury salary are they getting?
3:55 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
We take the date of injury as the marker for their earnings: what were they earning at the time of the accident? We take their gross pay over four weeks prior, for the first 12 weeks. We take their gross pay, then we deduct CPP, EI, and income tax. That gives us a net average earnings. Then we pay 85% of net average earnings.
3:55 p.m.
Liberal
Colin Fraser Liberal West Nova, NS
Okay, their income is at 85% of what they would have received had had they not been injured.
3:55 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes.
3:55 p.m.
Liberal
3:55 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
That gets into the legislation. I believe part of it is that there are some cost savings for the worker when they are off work, with their not going to work, in terms of transportation and all of the other factors that would be involved in their ability to earn. I believe that is the fundamental factor.
3:55 p.m.
Liberal
Colin Fraser Liberal West Nova, NS
If the worker is able perform some other task or duty or be financially compensated in another fashion while they're on workers' compensation—for example, an at-home business or that sort of thing—does WSIB take that into account in determining whether or not they are eligible?
3:55 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Their eligibility in terms of our suite of benefits starts when they have an accident on the job that's allowable. Following that, we assess their ability to earn. If they are unable to earn anything, then we will pay them the full amount, 85% of their net...while they are recovering, and we get them into treatment, etc.
We focus on abilities. So, at the very beginning, if the worker is able, it's part of the employer's obligation to offer modified work. If that modified work is at a wage loss, then we will compensate the worker 85% of the net difference. Even if they could work two hours a day, as I explained a little earlier, we would compensate the worker for 85% of the difference.
If the worker were to start a home business, that's a little different because they are taking themselves outside that employer/employee relationship in terms of our claim, and that would indicate to us that the worker has abilities and we'd go back to the employee and say, “If you can work at home, you can work with your employer.” If the employer, for some reason, shuts down or is unable to return someone to their employment, then we'd look at the worker's abilities and opportunities beyond the accident employer. We'd go through an assessment of their abilities to earn outside of the accident employer based on their current skills and abilities. We would then start a rehabilitation program tailored to them in order to maximize their earnings potential, and would support them through the schooling or whatever is required for that. Then we would hopefully place them in a job.
3:55 p.m.
Liberal
Colin Fraser Liberal West Nova, NS
I would imagine there are some cases where it's clear that the person is unable to perform the duties they had in their workplace, and then there are other cases where it's not so clear. Mental health, addictions, and these sorts of things may be not obvious.
Can you give me some idea of how that assessment is made? If there is a disagreement between what the employee is saying they're able to do and what the employer is saying they should be able to do, how is that resolved?
3:55 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Again, the quarterback, the case manager, is the first person who really takes that issue on. When we first get a file and it's an allowable claim, we do a very thorough assessment of the worker and their abilities, their skills, their barriers, and their medical situation. As well, we do an assessment of the employer and their abilities and history in terms of returning workers to function.
We also have a right to gather all the related medical information with respect to the area of injury, and we facilitate care to make sure that the workers get the best possible treatment early.
We have a very good, sound understanding of what their physical abilities are, typically before we get involved in a return-to-work intervention, so to speak, or before we plan it.
With regard to disputes over that assessment, we try to use the worker's physician's reporting as our primary source of abilities, because the worker has the right to choose their own physician. Where a file or a medical case does not progress as we would expect—for example, in the case of a strain, where there seem to be other things lingering, etc.—then we would employ some of our specialty clinics or preferred providers to give the worker an elevated type of care, for example, a specialist or whoever, and at the same time involve the treating physician so that everyone is roped into the findings.
In the end, we try not to make our decisions based on what the employer says, because they have no idea what the worker's abilities are in or outside the employment. We look at the medical assessment of the worker, and we try to come to an agreement with the worker of what their abilities are—not necessarily their work abilities, but what their abilities are. We then require the employer to try to match their abilities to the workplace.
It might be that they can do only simple filing, but at least we get the worker into the workplace, and that's our goal from the very beginning. As you heard earlier, we see positive collaborative relationships occur when someone gets back into the workplace.
4 p.m.
Liberal
Colin Fraser Liberal West Nova, NS
If there is a dispute on a finding of fact that the WSIB has made a determination about the person's abilities that the employee doesn't agree with, is there a mechanism for them to challenge that—
4 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes, there is.
4 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
Yes, our first mechanism, really, is that typically in those situations we try to get one of our contracted physicians to call or to connect with the treating physician to discuss the findings. We find that dispute resolution technique positive, because when you have a clinician speaking to a clinician versus a government agency talking to a doctor, it doesn't always work out so well in our interest, so we try to get a doctor to talk to a doctor and come up with a plan.
If they completely disagree—the doctor says that this person will never work again, and we say, “Well, based on our physiotherapy findings and our guidelines, we feel this worker would have some abilities”—in the end that is a case where we would make a decision based on the facts and explain it all. There is also an appeal mechanism internally.
4 p.m.
NDP
Sheri Benson NDP Saskatoon West, SK
Thank you, Chair.
And thanks, John, for being here.
I have a couple of questions—two things actually. You talked about first responders and folks who would be dealing with traumatic and very hyper events, and said that those folks have a presumptive clause. I want you to talk about that. That's for a particular group of workers. There is some recognition that their work is different from others.
Could you talk about that a bit?
4 p.m.
Executive Director, Case Management, Workplace Safety and Insurance Board (Ontario)
There was new provincial legislation in 2016 that accepted post-traumatic stress for first responders. Within that bill they gave a list, and there are about 25 of them. I don't have them here today, but you're looking at ambulance drivers, police, emergency personnel, firefighters, so the people who respond to the worst parts of the human condition. Instead of their having to plead their case about their work environment, what we typically look for is that be diagnosed before they gain entrance to that presumption, and that that diagnosis is a DSM-IV diagnosis.
As I said earlier, a good point for you to pay attention to is that if they don't have a diagnosis, because they're just being treated by their family physician, that shouldn't bar them from gaining entrance to us. They're trying to navigate through the system and they're having issues. Life is difficult enough as it is, let alone when you're struggling with what you have, so we will pay for that assessment even though we haven't accepted the claim. We will allow them to get that diagnosis or lack thereof, in order for them to gain entrance to our suite of benefits.