1. Return to the 2005 Adjudicative Advice Document on the weighing of medical evidence and escalation protocol for obtaining outstanding medical evidence. The WSIB should return to its investigative mandate and give proper weight to the opinion of the health care professionals who treat the worker.
- The 2005 document clearly set out that the attending physician is able to evaluate the worker’s genuineness, sincerity and reliability in the description of complaints, symptoms and ongoing impairment. The failure to clearly position the attending physician’s opinion as one of prime relevance and weight downplays the value of the actual examination of the injured worker. For those compensable conditions that are not amenable to “objective” tests, such as pain and psychological conditions in which the injured worker’s experience is paramount, the attending physician’s opinion and assessment of the worker is vital and should be accorded the weight that it deserves.
- The revised 2015 Administrative Practice document states that pre-accident clinical records or chart notes are required in determining psychotraumatic disability or chronic pain disability or in circumstances where there has been a pre-existing condition. Injured workers may feel forced to provide this information in order to get a decision on benefits, when in reality there is no legislative requirement that prior clinical records or chart notes be provided in any circumstance.
2. In order to provide injured workers full access to timely and high quality treatment and rehabilitation services, ideally provided in their own community if available, WSIB needs to engage community based health professionals in a collaborative, respectful partnership.
3. WSIB should preferentially deal with treating health professionals. When there are gaps in health care information or questions about treatment, WSIB should address these first with the treating professional and only turn to other health professionals (Medical Consultants or 'paper doctors') when there is strong reason to do so. In order to support this goal, the system for requesting and collecting health care/medical information from treating health professionals must be revised to make it clearer, more efficient, discipline specific and sufficiently flexible to address patients with more complex challenges, i.e. multiple injuries, gradual onset or complex illnesses, chronic pain and mental health conditions.
4. All health care disciplines should be compensated for providing the required reports/documentation. Currently, Physicians, Chiropractors and Physiotherapists are the only disciplines that have a fee schedule for completion of reports beyond the initial assessment. Psychologists, Social Workers, Occupational Therapists, Massage Therapists and Speech and Language Pathologists are denied separate billing for preparation of required documentation beyond the initial assessment, such as progress and discharge reports. These health professionals are expected to either provide these services pro bono or take time away from already limited treatment hours, which deprives the injured worker.
5. WSIB policies and practices should direct adjudicators to gather written evidence from the worker’s treating health care provider(s) that a recovery has taken place before entitlement is terminated.
6. The WSIB should only use outside consultants on an exceptional basis. These consultants should have a high standard of qualification and experience and there should be review and input by stakeholder committee on the roster of these consultants. Adjudicators should provide clear and ample reasons when deciding to prefer the opinion of a medical consultant who has not seen the worker over the advice of the worker’s treating medical professional. Only medical consultants who have regulated complaint procedures can be used and they must be identified along with their professional certification.
7. WSIB should develop a protocol for proactively identifying psychological issues after a workplace injury and providing mental health treatment. The protocol should require early communication with injured workers advising that it is very common to experience depression and anxiety after a workplace accident, and advise workers that if they are experiencing psychological symptoms, they should talk to their family doctor. Treatment recommendations should be promptly assessed and payment for treatment covered by the WSIB. The WSIB should address psychological problems effectively and early, well before the injuries compound and the psychological injury worsens.
8. The protocol for addressing psychological issues should also recognize that the future course of some psychological disorders can be chronic or recurrent, therefore there may be a need for treatment after maximum medical recovery (MMR) has been reached and return to work has occurred. Maintenance treatment, currently denied by decision-makers, and/or timely detection and rapid response to future relapses or exacerbations is appropriate in the care of injured workers with such psychological disorders as Post Traumatic Stress Disorder, Major Depressive Disorder, Recurrent and complex Phobias.