Adjudication

More than half of the participants reported that their claims for WCB benefits were accepted without difficulty or delay, but at least six participants—particularly those with significant disabilities resulting from extended onset injuries and/or back injuries—reported various difficulties.  Three to five persons with multiple injuries/claims also reported difficulties, particularly with injuries they regarded as aggravations of pre-1992 injuries which were adjudicated as new injuries.

Two participants reported that they had difficulty getting the WCB to accept their claims for injuries they first thought were minor, and did not report. One participant waited approximately six months—and several appeals—before his claim was accepted.

“I didn’t think I’d hurt myself that badly, so I didn’t file a Workers Comp claim. That’s why they denied my claim when I did file it, because I didn’t fill out that green slip of paper. But when you’re a [occupation], you’re forever getting scrapes and bruises, and you don’t go crying to the front office saying ‘give me a Compensation form’ every time you rip a nail.”

At least six participants said that their WCB benefits were ended before they and their physicians believed their injuries had healed sufficiently to allow them to return to work or become re-employed.

“They’re not listening to our doctors. They go by their book. They say ‘you’ve been off for six months. For your injury, the book says you should be back at work.’ Click, that’s it. And if you don’t go back to work, you don’t have a job. You’ve got no backing, because your doctor doesn’t count.”

“They give you so many months, and if you’re not cured, that’s too bad, you’re off. That’s the way Compensation treats you. They’ve got this book that says ‘for this you get 15 treatments, and you’re gonna be just fine, because we say so.’ There’s no consultation, no examination. I was never ever examined by WCB.”

Three to five participants reported that their adjudicators had changed two or more times during their claims, often causing frustration for the claimant because each new adjudicator was not familiar with the injured worker’s claim.

“My adjudicator has changed three times already, and that’s not right.”

“I never did talk to the adjudicators much because—every six months—they changed them. So they don’t really know your file.”

Three to five participants indicated that they felt adjudicators had not given sufficient consideration to medical opinions provided by specialists and participants’ personal physicians.

“I’ve had Comp doctors who have never seen me make decisions about my claim. One signed off on a denial of an appeal. How can they make decisions affecting your life without actually examining you?”

“All of the doctors I’ve dealt with have told me ‘we’ve had it with Workers Comp.’ They say ‘we write down everything, we give the objective findings, but Comp takes the portions that they feel are relevant,’ or they take what the doctor has said out of context, and they basically make it fit whatever they wanted to do anyway, or dismiss it completely.”

Wage Loss Benefits

At least six participants commented about the economic impact of their wage loss benefits being reduced from 90 per cent to 80 per cent of their net pre-injury wage after two years.

“We were getting by on the 90 per cent, but when they chopped it down to 80 per cent, that really hurt.”

One participant who felt his severe disability would prevent him from ever working again felt that wage loss benefits should be increased after two years, not reduced.

“I’m getting 80 per cent of my wages. When you’ve been used to making good money, it’s like being on the poverty line. And I could always do extra work when we needed extra money. I can’t do that now…When they determine that you’re permanently disabled and incapable of working, why can’t they take you back up to 100 per cent of your wage instead of cutting you back to 80 per cent?”

Two participants reported that they were not formally notified that their benefits would be reduced from 90 per cent of net to 80 per cent of net.

“I didn’t know it was coming. All of a sudden, boom, there it was, and that was a bit of a shock.”

Other participants recalled receiving advance notice of the reduction, but found the timing ironic.

“The week they told me they were cutting me from 90 per cent to 80 per cent, that was the same week they gave [approximately ten] million dollars back to the employers.”

Three to five participants reported that their WCB benefits were substantially less than 90 per cent (or 80 per cent after two years) of the net amount they were earning at the time of their injuries. These were most often workers in occupations which paid bonuses, or where there was substantial but irregular overtime. Others who worked in occupations with seasonal or yearly fluctuations in income reported that their benefit calculations were based on an average of their previous one or two years’ incomes. One participant who was injured shortly after starting a new job reported that his benefits were calculated on an average of his income over the previous two years, which were poor years for the industry in which he worked.

“I was flat on my back…You need your strength to say ‘I think this is wrong, I don’t agree with this.’ I don’t know whether it would have made any difference. I was just told that was it. At the time, I thought there wasn’t much use in fighting it. And then, always in the back of your head, I’d heard that it [benefits] could be reduced [further]. It’s a little fear thing, almost like a threat. You can appeal it [income averaging], but it could go the other way too.”

WCB claimants who become employed but are earning less than their pre-injury wage may continue to receive some wage loss benefits to bring their total earnings to 80 per cent of their pre-injury earnings (90 per cent during the first two years). Three to five participants who were employed (or anticipated becoming employed soon) noted that claimants who are working and earning less than 80 per cent of their pre-injury wage have little incentive to take overtime, pursue promotions, etc. because any increase in their earnings is deducted dollar-for-dollar from their WCB wage loss benefits.

“When you get a [wage] increase, they [WCB wage loss benefits] decrease…If I decided to get a part-time job, anything I make there would be taken off what they [WCB] give me.”

“When you get back to work, you should be entitled to what you were earning when you were injured, not 80 per cent. There should be some incentive to working. Even 90 per cent would be some incentive.”

Loss of Employment Benefits

At least six participants were dissatisfied with the loss of employment benefits (healthcare, dental, CPP, company pension, Employment Insurance, etc.) while collecting Workers Compensation benefits.

“They take off what you were getting deducted for Canada Pension Plan and Employment Insurance, yet they don’t pay that money into CPP or EI.” ^[41]

“You lose a lot of other stuff. I lost my dental, I lost my medical. I’m not paying into Canada Pension.”

“We shouldn’t lose the benefits we had with our employer…When your union negotiates a contract with your employer, benefits have a monetary value. Once you’re on [WCB benefits] for a while, the WCB should have a benefit plan for long-term claimants.”

“It’s really nice that they’re paying me 90 per cent of my wage tax-free while I’m at home. [But] I would rather be paid 100 per cent of my wages, and pay all my taxes, my Canada Pension, and my company pension. The way it is, you suffer down the line when it’s time to retire…But I think the WCB is looking after that now. After you’ve had a claim for more than two years, they reduce your benefits to 80 per cent of net, but they put five per cent away in a little pension plan.”

Permanent Impairment Awards

More than half of the injured workers who participated in this study had received Permanent Partial Impairment (PPI) awards. Three to five others indicated that they expected to receive PPI awards in the future, but would not be assessed until the WCB determines that their injuries have stabilized sufficiently to accurately measure the extent of their impairments.

Some participants declined to reveal the percentage or dollar amount of their PPI awards. Others indicated that they did not remember the figures. Of those who described their PPI awards, approximately half received awards in the 10-14 per cent range. Approximately one-quarter had awards of 15-50 per cent, and approximately one-quarter had awards greater than 50 per cent. The dollar amounts of PPI awards ranged from approximately $1000 to almost $100,000.

Almost all participants with PPI awards under 50 per cent were dissatisfied.

“There is no fair payment. I’d give back all the money, I’d go work two minimum wage jobs if I could [return to pre-injury condition]. There’s no payment high enough. I used to do everything in the world. Now I can’t play [various sports], even playing with my kids. I’d give everything back in a heartbeat.”

“They have a formula they use to determine what the payment will be. I was at [approximately ten] per cent. I don’t think that—by any stretch of the imagination—pays me for my lifetime impairment.”

One participant who received a PPI award of approximately $1000 reported that “my VRC told me that before 1992, I probably would have been looking at over $100,000.”

Three to five participants—particularly those with back and soft-tissue injuries—felt that their PPI assessments did not consider the disabling effect of pain.

“They assessed me at [approximately ten] per cent impairment. That’s another thing I don’t agree with. I’ve got range of motion—I can move around—but it’s what happens after I do that that’s preventing me from going to work. Some days, I don’t have to do anything [to cause pain that prevents her from working].”

Another participant who sought advice on challenging his PPI assessment reported:

“I was told ‘don’t go there.’ He told me that I’ve already got the highest [PPI award] you can get for a back injury. He said that if you go back for a re-evaluation, your chances of being evaluated worse [greater impairment rating] are very minimal. He said ‘they’ll probably evaluate you better [lower impairment rating] and ask for money back.”

Three to five participants over the age of 45 felt that it was unfair that their PPI awards had been reduced by two per cent for each year they were over the age of 45.

Communication

Three to five participants reported that they were not informed of benefits and services to which they were entitled. ^[42] Some of these benefits/services were clothing allowances, specialized footwear, specialized beds, and respite relief for family members.

One participant described the difficulties his wife experienced taking care of their children and him while he recovered from his injury.

“It was a big strain on her. She damn near had a nervous breakdown. But a couple of years later, after we got through all that, I was talking to somebody who told me that I could’ve requested home care. A nurse would have come in to give my wife some time off. So I called my counselor and asked him if I could have had home care. He said ‘yes, but I didn’t think you’d need it, so I didn’t offer it. But if you’d asked for it, I would have given it to you.’”

Another participant said that:

“Everything I’ve ever got out of the Compensation Board, I’ve had to fight for. They don’t sit you down and tell you everything you’re entitled to. It’s the wrong thing to do to a person who’s injured. You’ve got enough on your mind.”

At least six participants indicated that they felt intimidated and threatened in their communications with the WCB.

“I just want Compensation to let me get on with my life, put me through my training, and then leave me alone. They think they own your life, and if you don’t do what they say, you’re not going to get your cheque. I was so scared of them. I was doing everything they said because I needed the cheque.”

“Every time I get a threatening letter from WCB, it sets me back again. I’ve had three threatening letters in the last year. How is that supposed to help me?”

Three to five participants reported past difficulties and frustrations contacting WCB staff by telephone, but many acknowledged that there have been recent improvements to the WCB phone system.

Confidentiality

Three to five participants stated that they felt WCB staff had improperly released confidential information from their files to employers, doctors, and/or other insurance providers (e.g. Manitoba Public Insurance).