The sorry tale of yet another legitimate WSIB claimant denied benefits

With David Marshall being re-appointed to another two years as CEO of Ontario’s WSIB, various public servant heavyweights have chimed in with praise for the man’s work in whittling down the agency’s unfunded liability. At $14.2 billion in 2012, it’s now apparently closer to $9-billion. That’s quite a turnaround.

Great news and responsible fiscal management, right?

Well, how you feel about the WSIB’s spending decreases depends on whether you are on the receiving end of a $400,000 bonus for effecting them, as David Marshall is, or whether you’re an injured worker who has been denied benefits.

Payouts to injured workers by the WSIB went down by $700-million between 2009 and 2013 – from $3.2-billion to $2.5-billion. The vast number of stories of workers being kicked off of apparently fully-legitimate benefits are all over the media, all over the web, all over the industry.

We all know that some people abuse welfare. We know that, sometimes, the WSIB gets fraudulent applicants. But the sheer volume of workers denied WSIB benefits these days seems to be a tragedy in the making.

Let’s just talk about one case. His name is Chris.

Chris is a dad of three young boys. Recently, I stood next to Chris as he watched his three young lads toboggan with his wife. It was clearly evident – from his cane and his difficulty moving around – why Chris wasn’t joining in. I asked him about his injury – his life-changing moment.

It was this. While unloading steel beams off a semi trailer in 2013, a beam swung around and hit Chrism on the head, knocking him flying off the trailer, onto the ground and into a coma for 3 to 4 days.

Chris sustained back and pelvic injuries and, worse still, he lost his memory. He had to be told, “Your name is Chris.”

“This, Chris, is your wife. These, Chris, are your boys.”

Can you imagine this situation? Chris’s memory is still missing in action and his oldest son is now under therapy, possibly partly due to the new version of his dad that lives at home.

I proceeded to offer Chris the optimistic statement: “At least WSIB is looking after you, I would expect?”

Chris swept his arm across the sky and almost spat: “Those b……s cut my benefits off!”

WSIB deemed Chris fit to carry out modified duties, meaning the company had to take him back and give him a special job.

How do you think that worked out for the company?

How do you think that worked out for Chris?

How do you think that worked out for the WSIB?

Well, one of the above parties got precisely what it needed.

I will let you guess which one of them it was.

Chris’s medical diagnosis is Post Traumatic Stress Disorder (PTSD).

Here’s what the Canadian Mental Health Association says about PTSD.

Causes intrusive symptoms such as re-experiencing the traumatic event. Many people have vivid nightmares, flashbacks, or thoughts of the event that seem to come from nowhere.

Can make people feel very nervous or ‘on edge’ all the time. Many feel startled very easily, have a hard time concentrating, feel irritable, or have problems sleeping well. They may often feel like something terrible is about to happen, even when they are safe. Some people feel very numb and detached. They may feel like things around them aren’t real, feel disconnected from their body or thoughts, or have a hard time feeling emotions.

It seems in the claim process, WSIB use doctors who are aligned with them in order to adjudicate claims, especially when it comes to long term ones. If these doctors feel claimants are fit to return to lighter or modified duties, these workers are then forced back to work and off claim.

My question is: should a claimant not be allowed their own independent doctor who isre not tied to the purse strings of WSIB? Maybe doctors who also carry the same qualifications as these WSIB doctors? Do claimants not deserve an independent opinion? Why should they have to accept doctors who are not working at arm’s length from WSIB? I personally believe the present system is flawed and heavily favors WSIB at claim time.

Have any reader experienced WSIB claims or knows of others who were denied claims? Let’s talk about the good, the bad and the ugly of WSIB.

We at CARAHS is here to address any questions you might have on WSIB. Call us toll free 1 866 366 2930.

By providing education and training, CARAHS reduces your risk of fines, job site closures and prosecution under the Ontario Occupational Health and Safety Act. We are independent of unions and government.

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