Labour group concerned about WCB medical claim suppression

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This article was published 21/07/2015 (3975 days ago), so information in it may no longer be current.

Medical claim suppression.

While it is not a well-known term, it is a growing practice at the Workers Compensation Board of Manitoba according to a frustrated group of claimants and advocates.

“We’ve had a campaign for some time on claim suppression — when employers are actively getting involved in claims — but now another issue that’s been identified is when medical opinions are dealt with,” said Kevin Rebeck, president of the Manitoba Federation of Labour, a provincial workers advocate.

Rebeck says while it is too early to tell the scope of the issue, he has come across several cases where the WCB has ignored legitimate medical evidence to avoid paying compensation.

“The surface evidence that I’ve been seeing causes me to have some pretty big concerns that people aren’t getting fair treatment,” he says.

John (TJ) Phillips is one of those people.

When Phillips fell into a trench on a job site in 2012, he had no idea just how painful the road to recovery — and retribution — was going to be.

For the past three years, the 33-year-old Manitoba Hydro employee has been trying to get the WCB to recognize the severity of his injuries.

Phillips, who was working as a lineman at the time, was straddling a ditch when the earth beneath his right foot gave way.

“It was only about three-and-a-half to four-feet deep, but it was enough to jar me,” said Phillips during a phone conversation with the Sun.

His body twisted awkwardly during the fall causing his back to hit the ground first. Phillips continued to work for several days until the pain in his lower back and right hip became unbearable.

He visited a doctor in Stonewall on May 23, 2012, who suggested the injury was a hip strain and wrote an incident report to the WCB.

Coworkers at Hydro were able to verify Phillips’ claim and the WCB agreed that he had suffered a workplace injury. The problem was the board decided his injury was only a hip and back strain, even though MRIs and CT Scans taken after the accident showed two herniated discs and other trauma in his lower spine.

“I handed in all of the medical information I could think of,” said Phillips. “(The WCB’s) consultant, when he originally diagnosed me, ignored a bunch of information that was in doctors notes.”

The WCB agreed to compensate Phillips until July 23, 2012, which the board figured was enough time for his “hip and back strain” to heal.

He continued working during the summer and while there was a brief period of improvement thanks to physical therapy. He was taking as many as eight Tylenol 3s everyday to deal with the pain in his back.

“It had gotten so bad that I could barely move,” said Phillips, who was restricted to light duties and office work in October.

In January 2013, Phillips was in his backyard bending down to pick up after his dog when something in his back popped. He returned to his family doctor complaining of a significant increase in lower back pain that was now radiating into both hips and causing numbness in one leg.

Phillips was off work at the time because of a recent surgery to deal with carpal tunnel in one of his hands — an issue unrelated to his current claim. The WCB cleared Phillips for work in February, but his intensified back pain made it impossible to go back at that point. Without wage compensation benefits, he had to use banked vacation and sick time to recuperate.

Phillips tried to get further compensation but was rejected because, according to the WCB, his current back issues where related to a degenerative disc condition and a 2001 car crash he had been in when he was 20-years-old.

“I’ve worked 10 years between then and now with no issues and I didn’t start having any issues until I fell,” said Phillips. “Which has also been corroborated by a 2006 MRI I had, which didn’t show the level of damage that they’re trying to attribute to my car accident.”

This 2006 MRI showing Phillips’ fully-recovered spine, became the foundation for his medical suppression complaint with the WCB.

Garnet Boyd is a case manager at the Brandon and District Worker Advocacy Centre and says the WCB often leans heavily on the “pre-existing” condition trope.

“The biggest issue with WCB is when you have a claim number, you’re claiming that a specific incident…created the injury that you have,” said Boyd. “So, if you have a pre-existing injury they’ll say ‘well this incident just aggravated (it)’…they deny the claim and say it was not a work-related injury.”

Boyd tries to gather as much evidence as he can when advocating for a worker. Recently, Boyd has encountered doctors who don’t want to write reports for his clients because they know their opinion is going to be ignored by WCB.

“The case manager with WCB will usually side with whatever their WCB doctors report says…very seldom do they ever side with a family doctor,” said Boyd. “That’s where our doctors are getting frustrated.”

When it was clear WCB wasn’t paying attention to his 2006 MRI, Phillips sought out a specialist with MFL for a second opinion.

Doctor Robert Chase examined him and looked at his all of the MRIs and scans in Phillips’ medical history. Dr. Chase agreed that Phillips’ back pain was the result of his workplace injury in 2012, an opinion he expresses in a letter to the WCB.

In the letter Dr. Chase states that “Mr. Phillips made full recovery” between the car crash and the fall, citing several physically demanding jobs, including working in the oilfields, Phillips held between the two incidents. Dr. Chase affirms that leading up to May 2012 Phillips “was able to preform his duties as a lineman without pain impairments, analgesic use or lost time.”

In December 2014, Phillips received a letter from the WCB saying that despite the new medical evidence and Dr. Chase’s support, his appeal has been denied.

At this point, Phillips began to worry that the evidence he was submitting to WCB wasn’t getting into the right hands.

“The office staff at WCB are making decisions to ignore medical information and not have medical personnel look at it,” he says.

In January 2015, Phillips requested a medical review panel and Dr. Chase wrote another letter on his behalf.

In yet another rejection letter from the WCB, a case manager compared the evidence brought forward by Dr. Chase and the evidence brought forward by the medical consultant hired by the board. The manager writes, “It is my belief that Dr. Chase’s current opinion is not supported by a full statement of the facts.”

“How do you ignore doctor’s notes and other information that is clearly there?” asks Phillips.

Deana Martz is an officer for the Fair Practices Advocate, which is an organizational ombudsman for workers and employers. Martz says WCB’s adjudicators and consultants base their decisions on more than just a doctors note.

“It’s only one piece of evidence, (a doctor’s report) is an important piece of evidence…but it’s not the only piece of evidence that the decision maker has to consider,” said Martz. “Sometimes the doctor will say well, yes that could’ve happened at work, but they don’t know, they weren’t there, they’re not phoning the employer or… talking to the coworkers.”

For Phillips, understanding the decision-making process doesn’t give him peace of mind.

“The most frustrating part is definitely having legitimate medical information and just being shut down,” he says.

In March 2015, Phillips returned to Hydro as an office worker. He had been on employment insurance for more than a year and had to push Great-West Life, Hydro’s insurance provider, to get him into a work rehabilitation program.

“Everyone was more than happy to have me languishing on long-term disability making peanuts.”

While some aspects of his life are on the mend, other parts have been damaged irreparably by his dealings with WCB.

“My wife and I are separating now just because of the ridiculous amounts of stress that we’ve had to go through for the past few years.”

Phillips hopes MFL’s medical claim suppression campaign will lead to a breakthrough in his case.

This week, Rebeck is having a meeting with several workers and doctors to talk about the issue of medical suppression. He wants to bring their grievances to the WCB in order to start a conversation about organizational reform.

“If there is differing opinions we need to make sure that there’s a fair system that finds the balance and builds that consensus instead of on that just picks one view,” Rebeck said.

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