Royal Commission on Workers' Compensation in BC
Feb 20 Full Day Session
Name: Ron Buchhorn
Title: Vice President – Rehabilitation and Compensation Services Divisions
Affiliation: Workers' Compensation Board
Staff Present: TR, GG, OE, GS, SN, PL
Notetaker: Steven Noble
Date: Friday, February 20, 1998
GENERAL COMMENTS
- Topics today include: Compensation and Adjudication
- Adjudication Models
- Statutory and Policy Requirements
- Evidence Gathering
- Medical Issues
- Delays (Service Delivery Initiatives)
- Accountability
PRESENTATION
I am pleased to have the opportunity to present a brief overview of the issues associated with adjudication in the compensation and rehabilitation services division. Particularly where we were, where we are today and where we hope to be by the end of 1999.
When workers are injured or become ill because of their jobs they expect and are entitled to income continuity, effective treatment, help in returning to work, and respectful service – all goals of the Workers' Compensation Board strategic plan. Very little of our business processes are the same as they were 3 years ago when I was appointed to my present position within Compensation Services. I would like to commend the management and the staff of our organization for continuing to improve on all key performance indicators in the midst of sweeping technological change which has affected every employee in our organization. I would also like to recognize the Compensation Employees Union for its leadership in dealing with very complex labour relations issues that such transformation brings with it. It is hard for me to believe that just three years ago we were a bureaucratic, paper-based, reactive, and inwardly focused organization. While we have a long way to go our transformation to a compassionate, pro-active, workplace based, and service driven organization is well underway. Central to this new way of doing business was our investment in our electronics claims processing system or EFILE. This system has allowed us to change our adjudication model to incorporate call centre technology with expanded hours of service. Central adjudication of complex claims and decentralized delivery of ongoing service to workers and employers to our interdisciplinary workplace based case management initiative – Ian Munroe, our Executive Director will be speaking to these initiatives in more detail. Our staff was pleased to have Judge Gill and Commissioner Stoney visit our Prince George Case Management Pilot to experience this new service in person.
When we last presented an operational review to the Commission we stated our intention to re-engineer the adjudication process from least complex to most complex claims. Our initial effort was to improve front end processing with much higher income continuity and client satisfaction outcomes. The next area of change was in the complex entitlement of claims where we have achieved improved income continuity, improved timeliness of decision making and triaging of clients into our soft tissue continuum of care and with achieved a significant reduction in the number of adjudicated claims on our 28 day list or our 28 days after receiving application.
One side of the call centre or the entitlement unit has accepted claims; certain injuries or clients are triaged immediately into our case management process. This allows an interdisciplinary team comprised of a case manager, vocational rehabilitation consultant, psychologist, physician, occupational health nurse, and a prevention officer to discuss the claim and develop a medical, clinical, and return to work plan.
The role of the Board physician in that model is transformed from that of a gatekeeper to that of a collaborative resource to the attending physician. By jointly developing a medical and a clinical care plan the Board’s physician and the worker’s attending physician minimize the opportunity for conflict and work as a team in the best interest of the injured worker. By visiting the workplace to develop a return to work plan with the employer, worker and worker representative the case manager becomes a facilitator for the employer and the worker to engage in early, safe and durable return to work. On another front the board has come under heavy criticism for its adjudication of activity related soft tissue disorders or activity related soft tissue disorder.
We recognize that work site visits to assess risk factors are fundamental to carrying out our mandate in accordance with Chapter 4 of our policy manual. To improve our performance in this area we have recently trained an external provider network of occupational therapists and we have trained our adjudication staff on a workplace based assessment process for the adjudication of activity related soft tissue disorder claims. Where our staff do not have the skills to engage in a proper ergonomic assessment of the workplace to determine entitlement and engage in preventative measures they will be accompanied to the workplace by a trained occupational therapist. This professional will assist in the workplace assessment and assist the worker and employer in making job modifications where appropriate. Our prevention division will receive data from our claims experience and from this initiative by employer and by industry and this will assist them in their workplace targeting.
In addition on the subject of activity related soft tissue disorder claims Dr. Michael Woodchuk of the Alliance Healthcare Group – one of our clinical rehabilitation providers – is collaborating with our medical department to institute a best practice rehabilitation continuum for activity related soft tissue disorder injuries.
Once this protocol has been developed workers will receive therapy through our provider network for these injuries. The last area of concern in the adjudication process has been in the disability awards area. Injured workers queued for up to fourteen months for the determination of their pension entitlement. Our existing process again were internally focused, rife with re-work, and inconsistent in the area of impairment evaluation. In collaboration with the ARCON Corporation the Board has developed consistent protocol and procedures for the medical evaluation of functional impairment.
In the area of subjective complaints the Board is evaluating protocols that were developed by the North American Disability Evaluating Professionals or NADEP.
In addition we have written our disability evaluation schedule into our software so that we can now calculate percentage of impairment formulas automatically as opposed to by hand. A proof of process pilot is being conducted in the Lower Mainland as a joint initiative between Disability Awards, Medical Services, External Providers, and ARCON Canada. Our objective is to provide consistent, repeatable Permanent Functional Impairment exams, streamline the pension calculation process and improve customer service by reducing pension processing times from months to weeks.
As you have observed there is much activity and change occurring within the Compensation and Rehabilitation Divisions. Our management team was not and is not yet satisfied with the service that is being provided to our clients - the injured workers and employers of BC. Much improvement remains to be done. As in any large organization change is difficult to implement particularly when steeped in culture, as is the Workers' Compensation Board and its related agencies and stakeholders. To complicate our situation change no matter how well intentioned is never easy within the workers' compensation system. Stakeholder trust of the Board has never been high. With any change accompanied by much skepticism and cynicism. Despite this I am proud of our management and staff who have been resolute in their determination to improve our service, improve public and stakeholder confidence and return the Board to fully funded status. We remain one of the few boards in Canada to have achieved fully funded status without having to reduce worker benefits or changed our very conservative actuarial assumptions. Let me take a brief moment to share with you our progress on some of our divisional-wide key performance indicators and then Ian Munroe will briefly share our new adjudicative model with expected outcomes. Following that we would be pleased to answer any questions.
Whose Fault Was it –There has been much discussion on how did we get ourselves into the mess that we seem to have been in and I use a quote from Deming because it is not appropriate to blame other people, I don’t’ think, for this situation. And Deming basically said "When you find service or performance failure 85% of it is caused by your business processes not by the people involved. And that is what I’ve been saying to our staff for the last three years because it is not your fault that you were given a 1950’s paper-based system that had not been re-engineered, that had not had investment in technology to do your business. And it is small wonder that we were failing. In terms of claims first reported to the Workers’ Compensation Board you can see that since 1990 we have had a slow decline in the number of claims to 186,000 in 1997.
In terms of income continuity which is how many workers do we pay within 17 days. The 17 days is the three-day reporting period and then a two-week pay cheque. That is how the corporate standard of 17 days was arrived at.
You can see that over the last ten years – in the last two years we have achieved higher income continuity than at any time before in the history of the Board. In addition to the 61% of workers who receive their pay cheque within the 14 days from application there are a number of public sector employers who maintain income continuity for their workers. Now that is a great advantage to workers so all hospitals, municipalities, BC government, federal government employees continue to receive income continuity and the Board reimburses those organizations for Workers' Compensation Board payments.
So the good news is that the income continuity level is higher than the 61% if you factor in the public sector, however, the problem with that is that because public sector employers maintain income continuity there are extremely tardy in reporting injuries to the Board which creates a significant problem for our adjudication process. It is not unusual to find 28 or 25-day delays in the reporting of injuries in the public sector.
In terms of average Timeliness in decision making –so I’ve shown you the income continuity that is achieved – what about average timeliness of decision making and we have reduced that from 28 days in about 1994/1995 to about 21 days in 1997 –and our strategic plan and corporate business plan calls for a 17 day average timeliness of decision making. We believe that is achievable within the next two years.
Duration of Claim – how long are people off work when they file a claim -in the aggregate sense – and you can see that in the late 80’s and prior to that the duration of claim averaged about 35 days – it went up significantly in the early 90’s to a high of about 45 days and then it came down to 40 days in 1996 and it has gone up to 42 days in 1997. Without good data – without being able to break down your mix of claims and analyze by industry, by employer what is happening with your claims inventory it is very difficult to speculate about what causes increases and decreases in duration. Certainly adjudication practices have a role in that - the mix of claims has a significant role in this particular indicator. We are getting the type of data that Mr. Fattedad was able to show you on the employer profiles with respect to what is happening in the claims arena.
The prior slide was total duration – so that is all claims – all years – this is – how about injuries that occur this year that are closed this year and the worker has returned to work and again you can see that we were slightly trending up for a few years in the early 90’s and then we started to trend down and then in 1997 we’ve had a slight up-tick.
Our 28-day list is important to us from a client service perspective –these are the number of workers who are sitting in our system for more than 28 days that have not received an adjudication decision. You can see that over the last three years we have put a lot of focus on this and again Mr. Munroe will speak to the new business processes and how we have been able to achieve the reduction from about 4500 people who were waiting in the system for a decision down to the current level of about 1300 - 1400 people. Now some of this is beyond our control –in this population of 1300 you will find people who have been involved in motor vehicle accidents who have the option of going either Insurance Corporation of British Columbia or Workers' Compensation Board. They have 90 days to make that option so they would be in that inventory of 1400 people waiting for a decision because they have not yet exercised their option in terms of which system they wish to use.
Total Wage Loss Days’ Paid –again a fairly dramatic increase over the last ten years – reduction in the last three years and then an up-tick to almost 3 million days’ paid in 1997.
Disallowed Claims –you can see that over the last ten years this has not been a flat indicator – it has gone up, down, sideways – in the mid 1990’s the disallow rate has increased and then has rolled over and come back down again. I’m not going to deal with that in a whole of detail in my opening remarks. I suspect that Mr. Steeves and Mr. Sayre will have some questions with respect to that particular indicator. The Disallowed Rate as a percentage of claims filed within the system – again - is running at about 4-½% in 1997. It was historically running at about 3-3 ½% and I believe that Mr. Pinto, earlier in the week, talked about some of the reasons why we believe that the Disallow Rate has started to rise; the mix of claims is different. We are seeing a lot of claims that are not traumatic injuries – they are much more difficult to adjudicate in terms of causation and certainly that would have an impact on the Disallow Rate given our current legislative and policy parameters.
Appeals Received by the Review Board –we tracked this as an indicator both from a client satisfaction perspective and from a quality assurance perspective. We can see that appeals rose fairly dramatically in the early 1990’s and then has fallen in 1997. We attribute that fall to the implementation of the continuum of care, which has taken a lot of tension out of the system around short-term disability claims. Claims closure is no longer acceptable as a solution. We believe that return to work is what we value in the organization and that has taken a fair bit of the tension out of the appeals process with respect to short-term disability.
We also track - Appeals Received by the Review Board – Part 1’s and Part 2’s – and you can see for the last year and a half the number of Part 1’s being filed at the Review Board has fallen off fairly dramatically and again we believe that’s a result of the focus on early and effective treatment and return to work initiatives.
While the appeals had been going up in terms of number of appeals filed which is the yellow and red snack bar it is interesting to note that actually Review Board Findings – it is interesting to note that the actual allow rate in terms of allowing of appeals has remained fairly flat. So while the volume has increased the number of allowed claims has remained flat so as a percentage – the percentage of allowed claims has come down from an historical of 44-45% to about 35% in the last couple of years. And this just shows that again – what percentage of the time an appeal is filed at the Review Board is the Board’s decision upheld entirely and you can see that in the early 90’s and late 80’s the Board was only successful in 50-55% of the appeals that were moving forward. That has increased to about 65% and in fact I just got January’s numbers from the Review Board and that trend is holding at about 65% allowing of the Board’s decisions – 35% overturning the Board’s decisions in part or in their entirety.
If you are a worker or an employer and you wish to appeal a decision – how are we doing with respect to disclosure of files so that you can proceed with your appeal? You can see that again this area has been re-engineered with a significant new technological platform and if you wish to have your file disclosed at this particular time you will get it within 6 days on average. That’s down from many months earlier on. Now that is an average – there are some files that have lengthy delays associated with disclosure because in the paper world if your file is at the Review Board or the Appeal Division it doesn’t come out of there and so we can’t get our hands on it to disclose it. In the E-file world we can disclose that file while it resides in the Appeal Division or the Review Board or anywhere else.
Total benefit payments made to injured workers over the last ten years – and you can see that dollars went up significantly in the early 1990’s and has plateaued – reduced slightly in 1996 and then back up a bit in 1997. And the colour bars just indicate where the dollars are being spent. Red being the short-term disability; yellow being long term disability or pension component and on in the nature.
Productivity – it is very difficult to prove productivity in a paper-based environment unless you add staff, which diminishes your productivity or takes it into the negative. If you invest in technology – give people new tools we believe that we can improve productivity without adding staff or administration dollars. And the way we calculate productivity is how many claims first reported; how many staff in the Compensation Services Division and as a ratio then what is the staff per 1000 claims first reported. And there is the 10-15 year history of productivity. Improvements in productivity in the 80’s – primarily I believe associated with declining claims then a significant increase in the claims in the late 80’s and early 90’s and absent any kind of different way of doing business – your productivity is going to slip as the system becomes more complex. We’ve put a major focus on client satisfaction and as the Royal Commission is aware we survey 900 workers a month through the Angus Reid Group on a variety of indicators that they have designed in collaboration with stakeholders and you can see that when we started this process in 1996 we had a base line of 7.2 out of 10 or 72% client satisfaction. We have steadily improved that client satisfaction to the high of 83% in November of last year. This is sensitive enough to pick up peak vacation periods – Christmas periods – you’ll notice that in the summer and in December the client satisfaction goes down because more people are off with vacations. So it is an extremely sensitive tool – it allows us to determine what needs to be done – what needs to be done – with respect to staffing and we have engaged in a number of training initiatives including having all of our staff go through "SuperHost training", client satisfaction training, dealing with angry clients, a number of initiatives to improve the skills that our staff have with respect to dealing with clients.
I’ll turn the presentation over Ian Munroe who will deal with the new Adjudication Model and the Case Management Model and then as I said we’ll be happy to answer any questions.
IAN MUNROE
This initiative for the Compensation Services Division began in early 1995 under the umbrella of the corporate strategic plan. When we set out to really, totally look at the way we interacted with our claimants and our stakeholders and constituents with a goal of transforming service throughout this system and some of the indicators that I think Ron has shared with you demonstrates that we have had some success in that regard.
We also said to our staff that we would find time for them and for us. And over the years I think that that in fact has proved to be so as well.
In early 1995 we decided not to vet some of the conceptual thinking on the whole thinking but rather than doing that take some of the conceptual thinking of the organization that have been developed in the early 1990’s through some initiatives and take those thinking and those concepts and some base line technologies and demonstrate the worth of those in a pilot site. We took one of our Service Delivery Locations – our Coquitlam office – and moved it out of our main head office facility and moved it off site and if became our main R&D or research and development site for the better part of 2 years. And I notice this morning in our audience one of the adjudicators, Bill Brewer, is with us who participated during that timeframe in our research and development initiative. We established I guess four or five fundamental key strategies that we wanted to focus on through these initiatives – improvements in Client service; operational effectiveness – we needed to as we were changing the way in which we performed the way we interacted with clients and the new positions that we were establishing in our organization with new technologies; we knew that we would have to concentrate heavily in the area of staff development; and lastly we said we concentrated initially on the front end processes – eventually moved with a more intense approach to case management.
Ron talked about our 1950’s – like environment that was prevalent in that timeframe – in the Richmond Complex for example we’re receiving about 1.5 million forms from workers, from the medical community and from the employers. Those 1.5 million forms in this complex and roughly 3 million forms a year have to be – had to be manually processed in a very archaic way and one by one essentially to catch up to the claim. If someone called into the Board at that time looking for information in respect of their claim file it was very unusual for the person they got in touch with to in fact have the claim file with them so we would have to take a message, have one of our file clerks go into the organization somewhere to eventually find and locate the claim; bring it back to the officer and in time, which was typically a week or more, return the phone call to the claimant. Again because of the forms that were rattling around the system not all of the information would be in the claim file and obviously a very difficult task for our Board staff to try and improve our service in that kind of environment. When we look at just the "C" claims for example – our "C" claims are our more complex claims. It was taking us at that time on the left side – it was taking us 67 days to make an entitlement decision. And that was because of the information chase and the information waiting situation that we were in – waiting for the relevant information from the parties so that we could entitle the claim. So, over two months of waiting time before we were in a position to entitle and at the – during that time they were not in a position to effect a care management or a case management approach for those claims.
The features of the new model for the front end processing incorporated these elements: a very high concentration and focus on addressing the time lags – the drag time that it took us to receive information for adjudicative purposes – we felt the new model should be more specialized than the previous model that was in place in the organization. We thought that on site adjudication and case management was going to be very important for the organization and the ability to triage simple claims to more complex claims in the specialized model.
This is a busy slide but I did want to spend a minute on it in that EFILE has become our main information enabler for the Compensation Services staff and it has become I guess the hub of our information wheel and has – it has and is serving all of the organization from client service representatives – the entitlement officers through to case managers – including vocational rehabilitation consultants and the other members of our staff throughout the division as well as the rehabilitation centre.
E FILE has been incorporated as part of our overall information services strategy for the Board and integrates itself into our corporate data base structure and we, therefore, pass information to and will receive information from the other information systems that are being developed in the Board – whether it be assessments or prevention or other arenas of the Board. So this is being built – not in isolation from a divisional perspective but under the auspices of a corporate information systems initiative.
The other area that is relevant about this strategy and there was discussion about this yesterday and earlier this morning about the timeliness of receipt of information. We purposely put in place as part of our information systems strategy an EDI linkage plan between ourselves and injured workers, employers, and the health care providers with a plan to bring that information to us much faster through electronic means in field of data formats. And those initiatives and undertakings are in various stages of implementation but we do have a number of those under way and certainly would be prepared to talk about them in more detail if there is a wish to do so later. This has been a very major undertaking for us as a division and again has significant implications for our staff moving from a paper claim file environment into a fully automated, paperless environment.
Utilizing, then, that technology we developed a new business model and took a number of steps out of the process and essentially went to a three-stop model – from a client service perspective. Our client service representatives are now occupying or residing in four call centres located throughout the province. One in Richmond, one in Kelowna, one in Prince George to serve the North and one in Victoria to serve Vancouver Island. Client service representatives are the first point of contact for our claimants and for our other stakeholders and constituents and have online, real-time information available to them through EFILE. For example just to give you a feel for the volumes that they are handling in this new environment. Our Richmond call centre this week will handle roughly 6000 calls and each of the other three call centres will handle about 1000 calls each. So there is a high volume of interactions between our call centres and our clients and claimants. In the entitlement arena we are triaging more complex claims into the entitlement arena for the more complex entitlement decisions for time loss claims and then the last piece of the organization model is the case management aspect of it that I will speak about in more detail.
The client service representatives –I briefly mentioned is we think extremely important to the fabric of our new service delivery strategy. It is a new position – it’s a new classification with much improved training that has elevated I think our ability to serve and to communicate and interact intelligently and in an informed way with our claimants. The other important change that we’ve made as this model has evolved over the last three years is that we have introduced entitlement decision making to the role of a client service representative. They are dealing with what we call routine claims. And those in short form are best defined as those claims that are not protested – there’s a specific incident and there’s good medical information. That represents somewhere between 40-50% of the time loss claims. Our client service representatives are able to quite rapidly adjudicate those claims in a friendly fashion – getting in touch with all of the parties as part of the process and making a timely entitlement decision. Those claims then that don’t make that test are referred and triaged immediately into the entitlement arena for more complex entitlement scrutiny.
I’m now going to move to the Case Management Model –again similarly to the approach that we took with Coquitlam we decided not to take case management out to the organization at large in one fell swoop but rather pilot it and prove out the concept and refine the concept before rolling it out to the organization at large. We have had the pilot up and running in Prince George – our area office in Prince George for approximately one year and it has been running in one half of the Prince George office and we are just in the process of introducing case management to the other half of the office as well as our North Shore or North Vancouver claims office here in the Lower Mainland.
Again, in 1995 and early 1996 as we were surveying claimants and surveying the employers – we were having focus groups – we were listening to worker representatives and we were listening to all parties and when we talked about the more complex claims in the system there was unity of feelings about an opportunity for us to improve our overall service in respect to our more complex claims handling and also improve our ability to manage claims and improve return to work outcomes.
These comments and themes were very much consistent with workers, with employers and unions during those timeframes. The Angus Reid information very much substantiated that. Our "C" claims in November of 1996 have a – had an overall client satisfaction of 6.5 on that scale of 1 – 10 where our less complex claims had a satisfaction index of approximately 8.0. So there was a significant gap of about a 1.5% on the scale – some in the organization said that we should be understanding of that – that obviously more complex claims would have a lower satisfaction level and perhaps that is valid but nevertheless we saw that there was an opportunity for improvement.
When we looked just at the claims process in respect to the "C" claims handlings those that would be eventually handled in the case management arena – again we saw that linear pass off handling that was prevalent as well in the short term claims handling arena.
Typically as I mentioned earlier it was taking us 67 days to entitle a claim –we would then go into a kind of paymaster mode where we would pay the claimant every two weeks – we would typically get a form 11 from the attending physician every two weeks – and eventually we would move into a medial exams and team meetings at approximately 24 weeks – vocational rehabilitation perhaps as early as six months but typically much longer than that and no I guess overall care plan for the individual claimant in the system.
So we provided to our staff in Prince George - Guiding Principles –that we thought we could incorporate in an approved case management approach for those "C" claims in the system. We felt early intervention was extremely important – rather than waiting for time to drag on and take reactive measures – be proactive and much earlier in the management of claims; frequent visits to work sites – again we thought were going to be extremely important to this model so that we were dealing with workers – dealing with worker representatives and employers at the work site - understanding the needs of the parties – working more closely with the medical community and getting return to work plans established at their site as opposed to and through paper interactions.
I am going to spend a minute or two on another busy slide but just to give you the sense of the business model and for case management that was established as a result of those guiding principles through the Prince George initiative. And we are having our more complex claims referred in the case management either at day one or day two if they are identified through Triaging rules by the client service representative or latest timeframe week five if a claim has gone five weeks and we’ve not seen a return to work outcome from our entitlement arena that would trigger a claim into case management so we are now talking about a timeframe of days or at most five weeks. During the following week the case manager has a responsibility to review the situation on hand, be in touch with all parties and come back to a team meeting the following week and present to the team the information that he or she has available from the parties after having dialogued with all the parties with a base line case plan being formulated in their minds that they can share with the team – with our internal expert team and I’ll talk in a minute in more detail about who that team consists of. The next step then in the next week or so would be that the case manager takes out to the parties the case plan and insuring that the worker, the worker representative – if appropriate, the employer and the attending physician to a clinical care plan, sign off the plan so the intent of this is to ensure that the Workers' Compensation Board isn’t going in one direction, the attending physician going in another direction and the employer having a different view of what is appropriate in terms of a return to work plan but that all parties subscribe to and sign off on a plan. We would then move into program delivery agreed upon by the parties and that may be graduated return to work or it may be medical interventions or the continuum of care or other measures. Through the process there is ongoing results monitoring, EFILE being the enabler to this whole process and any corrective actions being undertaken not only by our internal team but by the external parties. That that is intended to give you a feel for the lifecycle – the approach that we are taking in a much earlier timeframe in respect to claims. The case manager has a new role and a new responsibility and new accountabilities in this model and really is the overseer of the claim from beginning to end for the claimant but is also responsible now for managing the team. And it is a very much changed role from that of the adjudicator in our current organization structure and the case manager then is responsible for overseeing and ensuring that the various parties and various activities in respect to these areas are being professionally managed at the appropriate timeframe and in the appropriate way.
So the Case Manager role is the primary point of contact for the worker managing the case through to conclusion, getting out in the work site frequently and having ownership and accountability from beginning to end. I’m not going to speak in detail to this slide this morning – Dr. Blair will be spending more time on it in his presentation on day two of the next session with us so later today we’ll have Dr. Don Graham who is our medical advisor from Prince George and Dr. Blair if there is a need to respond to questions talk about the role of the medical advisor in this model. We’re are also as a result of this change and to some degree the role of both rehabilitation consultants and other participants of the case management team.
The third busy slide – we are monitoring and tracking the activity of claims through the Prince George model and I just want to talk about a couple of highlights – of 2456 claims coming through the half of Prince George that is on case management you will see that 1200 – or roughly 50% are being able to resolved now by our client service representative in the call centre in Prince George without interaction or involvement by the other parties. A thousand of the claims are moving into our entitlement officer in that they have met the test for a more complex entitlement requirements so they have moved into entitlements for a more complex entitlement activity. One hundred and sixty-eight claims are immediately triaged into case management on a day one – day two kind of scenario and 195 moving down from entitlement to case management. The bottom line of that is roughly 17% of the claims that we are handling now in Prince George through the case management model are actually being referred into case management – that’s much less than our current model and much less than we anticipated going into this thinking that probably as many as 25% would actually be handled in case management.
So how are we doing? You’ll remember that in 1996 our "C" claims had an overall indicator of 6.5 – in September, 1997 through Angus Reid we re-surveyed or surveyed those claimants that had participated in - a sampling of those participants who had participated in the new model and you’ll see that their index had increased from 6.5 to 8.0. So we think from an Angus Reid client satisfaction perspective we have definitely had some significant progress. We have talked to and surveyed the other stakeholders and again the feedback that we are receiving is quite consistent. The employers, the physicians, unions and I think most importantly our staff, have found this model to be much more effective and much more proactive and impactful positively so for our claimants whom we serve. So we see that this model is definitely going to have impacts – very positive impacts for our injured workers, for employers, the medical community and our employees in the Workers' Compensation Board.
[Judge Gill]: Mr. Buchhorn, are copies of those slides available for the Commission either later this morning or at some point in time.
A: Yes they are.
QUESTIONS
JOHN STEEVES:
Q: Mr. Buchhorn, and members of your panel, the - first of all you’ll appreciate that – or let me ask you this is an on – this is a new project – the managed – the case management model, correct?
A: That’s correct.
Q: And there is - I looked at the Strategic Plan and there is some written up in there –and what other documents should we be looking at to understand the case management plan?
A: There exists business cases, process documentation, documents, I believe we have made them all available to the Commission we can certainly make them available to counsel if you wish those documents. This – the case management initiative in particular was written up at the conclusion of the prototype with the results, the challenges, the issues that needed to be resolved – we can certainly make those available to counsel.
Q: I appreciate that very much – if you could arrange that through Mr. Bates –
A: Yes.
Q: Thank you. Now before we get to that I think it’s important to understand where we came from –and that is before the case management model and in fact we are in a transition period now – correct?
A: That’s correct.
Q: And the – can we call the – first of all can we call it the previous model and can we call it an adjudication model just to give it some names?
A: We can although both are adjudication models.
Q: Yes, I’m just looking for a name that is different than case management. So can we call it&ldots;
A: The previous model and the future model?
Q: Yes. Well, okay – now the previous model was started in – what - the 1970’s and Chairman Eisen – have I got that right?
A: That’s correct.
Q: And the concept there – and I was looking last night for some of the early decisions – I didn’t see any that jumped out at me – but as I understand it the concept there was – that we would have well trained and well paid adjudicators with a degree of discretion and who would – who would control the file – is that your understanding?
A: That’s correct.
Q: And the – so the claim would come to the adjudicator, under the previous model, and the adjudicator would make the decision and about whether a claim should be accepted – the wage rate – the referral to disability awards – referral to rehabilitation – and the concept was that the adjudicator was - had the file and it was going out back and forth to the various people involved in it – is that a fair summary?
A: Yes it is.
Q: And just so we have it – in the – in the chapter 12 of the manual - the claims and adjudication manual – the claims and rehabilitation manual – this is the claims procedures – 96.20 describes – the claims officer or the claims adjudicator determines whether compensation is payable and so on –
A: Yes.
Q: And then in chapter 11 gives similar authority to the adjudicator – general referrals to rehabilitation services made by the adjudicator and disability awards for employability assessments and so on – so that is the previous model that we are talking about?
A: Correct.
Q: Actually I left one out – in chapter 12 – the 96 – no I’m sorry – 96.3 says that the disability awards officers, adjudicators determine whether a worker’s injury or occupational disease has caused a permanent disability so again that’s&ldots;..
A: Correct.
Q: The centre of the previous model is the adjudicator. Now the concept of the case management model as you say – are we calling that the current model?
A: The future model.
Q: The future model. So we have the past and future and nothing in the middle. And first of all the – we heard I think on Monday that the case management model has been approved by the Panel on the basis of regulation but not policy – is – have I got that right?
A: Yes. We have made no policy changes with respect to the case management model. We – it’s a resolution that gives the division approval to proceed with two pilots – one in Prince George – one in North Vancouver and upon conclusion of those pilots and upon having an evaluation of those pilots the Panel will make a decision on whether we proceed. Having said that we asked the Policy Bureau and we had our own policy and practice people review the way we would do business in the case management model to identify whether there were any policy issues that needed to be resolved. And there were. One of them was to change the word "adjudicator" to the word "case manager" which I think goes to Mr. McGinn’s point earlier in the week in terms of how detailed the policy manuals are. And whether or not that is a policy change.
Q: Yes and to be clear there is a discussion at the Board about whether procedures versus policy and whether it includes both.
A: Right.
Q: And so the panel has approved the case management model as a – by resolution – and as you say there are no changes to policy and to get it out of the way – there are no changes to the Act.
A: No and one of the – one of the purposes of the pilot will be to have experience with the model and identify potential policy or practice issues that may require change and the Panel would want to be apprised of that.
Q: Yes and some of those changes might be like changing the name of the manual from adjudicator’s to case manager’s and things like that.
A: Right. Or more significant.
Q: Yes – I was coming to that – now the - I’m looking at the slide –they aren’t numbered but – do you have that copy there?
A: Yes I do.
Q: It is the fourth page from the bottom – it says scope case management and circles around the – do you see that –
A: Yes I do.
Q: Now and then there is a slide before that –at the bottom of the previous page – and the first one – the top of the page where the scope case management slide - the case manager’s role – that is the case manager, correct?
A: That’s correct.
Q: And the concept here is that these various services – if you like - are spinning around and – with the case manager.
A: Well to the contrary – I think they spun around in the old model – they don’t spin around in this model.
Q: Okay – lets talk about that under the old model – the previous model –the - one of the – come to your point in a minute – but one of the problems for the worker in the previous model was that every time the phoned the Board or every time they talked to – got a letter from the Board it was from a different person.
A: Yes.
Q: I’m telling you anything new?
A: No.
Q: And what was the reason for that?
A: Well it was – it was not a simple reason – it was I think had many dimensions to it – one was the right of adjudication staff to exercise seniority – to opt into different areas of the Board or different Service Delivery Locations of the Board – a second reason was that people get sick; people take vacations etc. There are a number of reasons why that would happen – the file was not available to a particular decision maker and so as Mr. Munroe pointed out you would phone in – you couldn’t get satisfaction because the adjudicator would say the file is at the Review Board you have an appeal underway now would you like me to pull the file in which case your appeal will be delayed or would you like me to answer your question when I get the file back – so it was I think a very – as I said inwardly focused system that didn’t very well address the needs of injured workers to get information and get decisions.
Q: There is no dispute on this side of the room on that. The question is why –and if we just take those - your explanations in order –the third one – that is access to the file – and that is an EFILE question isn’t it?
A: I think we’ve resolved that through EFILE yes. I think there is simultaneous access to files now.
Q: Yes, so it is not a case management issue?
A: No.
Q: Yes; and the first two issues you gave - explanations you gave –about people bidding out to other jobs – people being off sick and on holidays and that – that is going to happen under case management as well isn’t it?
A: It won’t happen to the same degree because we have assigned teams of individuals to deal with specific employers and specific clients who would be employed by those employers. So&ldots;
Q: By clients you mean workers?
A: Yes.
Q: Yes.
A: So, if you want to have interaction with a case manager in Prince George and I happen to be off for a day there is a dedicated team assistant to the team manager and there is a partner to the case manager who understands that it is their responsibility to manage that particular piece of business for the person who is absent.
Q: But that’s different than one contact to the worker – you said three contacts?
A: The idea is that the service to the worker would be managed by this team and the case manager would be accountable for information, for decision making, for everything that we would hold the individual accountable for – consistency of decision making, quality of decision making – so I think the system brings accountability – it also brings a higher likelihood that you will be dealing with one person through the life of a claim.
Q: I’m not sure how&ldots;.
A: Mr. Steeves before employer based allocation of claims and before we went to the case management model our claims were dealt out like a deck of cards and so first in first out and it would just be scattered through a Service Delivery Location – you’d have an adjudicator dealing with every employer in a particular geographic location and every worker within a geographic location of many many square miles in the Lower Mainland. So there was no focus on understanding a particular employer’s business; a particular worker’s employment – so while I think Mr. Eisen had the best of intentions in creating a very judicial model for adjudication. It lacked the credibility of having the adjudicator whose making decisions about the lives of injured workers and their ability to support their families – it lacked the credibility of having them go out to the workplace to actually experience how an injured worker could be injured. So it is very easy to sit in an office – never having to look your client in the face – never having to walk through a workplace and make a very bureaucratic decision and that’s what the system I think was being criticized for. Now you may not agree but that’s why we’ve moved to this model.
Q: No – I think I partially agree for whatever my opinion’s worth but the – I think your historical comment of the previous model is fair comment –my question here today is whether – with greatest respect – this is attractive to workers cause it is a change – and the question is - is this a change for the better or just a change? And that is what I’m trying to explore.
A: Yes, and that is why we’ve surveyed workers to have them tell us how they’re experiencing this new service delivery model. We are quite pleased that there has been a huge improvement in client satisfaction to this model.
Q: Yes, I want to come to perceptions as opposed to results in a minute but the – in the case management model we have a case manager whose - I suggest has a very similar role as the adjudicator that is that person is the centre of the management of the claim A: That is true in the case management model that is not true in the past model because the past model was a hand off based system – so the adjudicator would do his or her piece of work and the file would be transferred to a vocational rehabilitation consultant. He or she would do his or her piece of work and then the file would be moved to disability awards and quite frankly if you were a worker in that system what we heard was there were major frustrations because not only was it a hand off based system there were significant delays at every step when your file got referred.
Q: Those are E FILE questions aren’t they –if we give the E FILE to the people under the previous model that solves that problem?
A: No, it doesn’t because the individual pieces of work would still be done by individuals. The technology doesn’t change the way you do business. Technology enables you to change your business processes. In a paper environment we could still effect I think a case management model – it would be very awkward and we wouldn’t be able to provide the same high level of response. But we could take a paper file as we do now in our Richmond Complex and we could sit these people around the decision table as we are trying to do while we are in transition and we could have the same input and that’s what I think is very useful from a worker and worker service perspective is that the adjudicator gets the immediate perspective of the vocational rehabilitation consultant and you immediately get the perspective of the medical advisor who says folks there’s going to be a functional impairment here let’s get started on vocational rehabilitation thinking – in the old model your permanent functional impairment happened three years post injury. The vocational rehabilitation would get the referral three years post injury and I’m sure you’ve seen files that show the outcomes of having people dealt with three years post injury. It is a very difficult client to deal with. If you can get these people at the table you can deliver services concurrently as opposed to consecutively so you can shrink a return to work for a very complex injury from three to five years to perhaps six months to a year. And now you have a client who is focused, who is motivated and who understands what he or she should get from the system. That’s the power of the case management model in my estimation.
Q: Are you saying that the sole reason for the backlog in disability awards was is because of the faults of the previous model?
A: No, I don’t say it is solely; I think in part it is, yes. I think – I mean what kind of a system would you design today where you would pass a piece of work that was this thick to a brand new person who would spend up to a week reviewing that entire file from start to finish to try to get a perspective of how that file had been managed for three to five years and then start making decisions on the file. Quite frankly it is absurd.
Q: Of course it is – but the question is whether it is going to change dramatically if I am a case manager and have that foot high file and then I bid into another job and somebody else has to take it over – if I am on holidays then somebody else has to take it over
A: But your team is intact so while the person may be on vacation or one person may bid out the team still has the entire understanding of how that claim evolved, the medical advisor is still a constant, the medical advisor has had discussion with the attending physician, the vocational rehabilitation consultant is at the table - understands why the plan was put together now having said that – there’s another I think a fundamental change in how we are going to do business and that is there is going to be a documented medical care plan and a documented clinical care plan and a documented return to work plan. Now that is absent today because the adjudicator quite frankly on complex claims may not think that their role is return to work - they may think that’s the role of the vocational rehabilitation consultant or they may think that’s the role of someone else in the system.
Q: Is it the plan to have a medical doctor with every case management team?
A: Yes, it is. And a psychologist.
Q: A doctor attached in that pod if you like?
A: Yes. One doctor per every Service Delivery Location and where we move to work centres and communities like Duncan and Penticton the capability for videoconferencing on the day that case management discussions take place so that the physician may not have to drive from Kelowna to Penticton on the day that the case management conferences are held. But through videoconferencing he or she will be able to participate, pull together the clinical care plan, deliver it to the team, and the team will then have their plan in place.
Q: In the Richmond Service Delivery Unit to which services employers in Richmond – is that correct?
A: Yes.
Q: How many case managers roughly would be required to serve that Service Delivery Location?
A: I believe we have 8 or 9 what we call in our current model – ongoing adjudicators which would become case managers and for those 8 or 9 adjudicators there is currently a medical advisor, a nurse advisor, and a psychologist assigned to that particular unit.
Q: And at any one time roughly how many files would be in the Richmond Service Delivery Location?
A: In our current model if we took an average of 80 files per adjudicator you are looking about 700 ongoing files.
Q: So if you walked in on any given day there would be 700 files in the Service Delivery Location?
A: Well, there wouldn’t now – there would be E FILE.
Q: Yes, yes so within the Service Delivery Location one doctor would be available on 700 files?
A: Yes, I think – what you are trying to demonstrate isn’t entirely accurate – the physician would be involved in the new referrals to the Richmond Unit of which there might be 20 per week and on those 20 per week the case managers would come forward with their plan in terms of how they intend to manage that particular file – they would seek advice in the meeting between these people or among these people of the medical input, the psychological input, the vocational rehabilitation input – many of these will not require the ongoing supervision of the medical advisor. Once the clinical care plan is put together between the attending physician and the medical advisor it is a case of implementation. So you don’t need the ongoing role of a medical advisor. And in fact that’s where we see the role of the nurse advisor. Is to give advice on the ongoing delivery of medical services to the worker.
Q: Yes, my point is – when the case management model is up and running there will be 700 – roughly 700 files at any one time in Richmond Service Delivery Location and there would be one doctor available for all those files?
A: And if necessary because of EFILE and if we – if we needed more medical resources we can through E FILE assign 100 files to another physician so it gives us the flexibility of being able to ensure that we have enough resources to manage this particular model. And in fact Dr. Graham in Prince George when he is here this afternoon will probably tell you that he has sent files down to his colleague in Victoria, Dr. Naismith, for a second opinion. I haven’t seen something like this before can you help me? So this model gives us a lot of resource flexibility.
Q: And how is this different from the previous model? Why couldn’t Prince George under the previous model send files down to Vancouver for a second opinion?
A: You could – you either had to photocopy the entire file which all sorts of problems associated with it or you could send it down by courier and a week later you’ll get it back. In the mean time if the worker phoned you say sorry I can’t handle your question because I don’t have your file here.
Q: But that is an E FILE issue not a case management issue.
A: In part it is an E FILE issue, yes. Yes, it is making the file available at all times.
Q: Let me move to some other areas perhaps with some overlap – just to get a few things out of the way – the - talked about medical staff and perhaps Dr. Blair will at least want to join in – first of all – I’ve shown you a document –it’s tab 14 – the form 6 – do you have in front of you still Dr. Blair? It is tab 14 in our documents Mr. Chairman – I put new documents in front of you this morning – Dr. Blair, or whoever else - this is a document from a client of ours – 2 documents from a client of ours –and the two documents are the form 8 or what is referred to in the business as the medical memo – the form 8 is filled out by the attending physician - is that correct?
A: That’s correct.
Q: And – in this case the doctor – the worker went to see the doctor and it was a locum by the name of Dr. Baren – and that name is down at the bottom as the signature of the physician?
A: Yes.
Q: And then the claim was made – I’m not sure – I assume it was made on the basis of the form 8 or the form 7- the claim was adjudicated within the Board and then memo 5 was produced within the Board and it resulted in a decision being made on the claim – and the decision – what the decision was doesn’t matter – but it is the same Dr. Baren – and first of all the worker didn’t see this until I got disclosure on his behalf and gave it to him and that’s the normal – so the worker received the decision denying the claim on the basis of a medical report written by Dr. Baren and he didn’t know that it was Dr. Baren that was behind the decision. That’s just the way the system operates – correct?
A: Well it shouldn’t operate that way.
Q: Well I want to come to the conflict in a minute –but just in terms of the worker doesn’t even usually see or know from the decision letter about who wrote the report – in fact
A: May not know.
Q: May not know – often they refer it to a medical advisor and they say this and that but they may not know
A: Right
Q: So I got disclosure and I presented these two documents to the worker and you’ll appreciate the worker was upset
A: Yes.
Q: And what I explained to the worker was that this was wrong - this is a conflict – and it shouldn’t have happened – do you agree or disagree with what I said to the worker?
A: I agree with that very strongly.
Q: Thank you.
A: I should also add that this issue came – not this issue but the issue of Board physicians practicing in the community came to my attention shortly after I assumed my position in the Compensation Services Division. And it came up in the context of one of our senior medical advisors who also practices in Tsawassen or in that area – when we looked at the issue we said because of the criticism that Board doctors sometimes receive about not being good community attending physicians we shouldn’t restrict the ability of Board physicians to go out into the real world and practice medicine. However, if any Board physician sees a worker in a private practice they must absent themselves from any involvement in the claim. And that was made very clear to all of our medical advisors by the senior medical advisors – now Dr. Blair wasn’t here at the time – he will follow up on this and ensure that that physician is again communicated because this is absolutely unacceptable from a conflict perspective.
Q: Yes and – we don’t need to spend a lot more time on it - it is difficult to imagine that the doctor who wrote the medical memo would not have looked at the form 8, isn’t it - I mean that is the first thing that they would look at?
A: It is hard to imagine, yes.
Q: Yes – this does - a number of these things starts to do damage to the system and the relationship between the Board and the workers?
A: These are the things that do damage – you’re right.
Q: Now - one of the things that’s happened in the last little while is – well first of all we have the new chapter 4 –and we have something called activity related soft tissue disorder’s which we used to call repetitive stress injuries and – I know what repetitive stress injury means – I keep forgetting – activity stress disorder
A: Activity related stress – soft tissue disorder or there’s a variety of takes on that but they are called CTD’s, repetitive stress injuries, activity related soft tissue disorders – a number of acronyms.
Q: Right and previously those were adjudicated within occupational diseases – ODS’s – correct?
A: Yes they were.
Q: And now they are adjudicated in the geographical units?
A: That’s correct.
Q: When did that change take place? Formally?
A: That change evolved in the latter part of 1995 – when I was receiving a significant number of complaints particularly from the labour community about the length of time it was taking for us to adjudicate activity related soft tissue disorder claims – in fact Mr. Georgetti wrote a letter to the Premier on this issue – in terms of the delays that were being experienced by workers – we decided for a number of reasons that it was not appropriate to continue adjudicating these claims centrally. One was how can you assess the risk factors set out in chapter 4 if you reside in Richmond and Vancouver and you can't go and look at a work site in Terrace to determine whether all of the risk factors that are set out are in fact occurring. They were sending out questionnaires and I found that to be extremely unsatisfactory – it did not have a high level of credibility with the worker or the employer and as a result we piloted moving activity related soft tissue disorder adjudication out to geographic areas – Courtenay and Kamloops – the staff were trained – we monitored the situation for I believe 6 months – and we then made a decision to roll out the training and the devolution of those claims to the rest of the geographic locations within the province. We monitored the results and in fact I believe somewhere here you’ve got the tracking that we do of the disallow rates – in particular with respect to activity related soft tissue disorder claims – where the disallow rate deviates from the average and the average is something that I am not particularly happy but where it deviates from the average we actually move in and do file reviews. And ensure that people are following the chapter.
Q: All right and I’ll come to that document in a minute - I want to discuss one thing you mentioned - the training that you did – in Courtenay and Campbell River were the two pilot places?
A: Courtney and Kamloops.
Q: Kamloops – and the training - can you describe what the training was in those two pilot places?
A: As far as I recall we put together an ergonomist from prevention, an adjudicator from Compensation Services, we invited a couple of people who were adjudicating in the occupational diseases unit, and I believe we had a policy person who devised the training with a particular emphasis on work site visits and then we rolled the training out.
Q: And how much time was spent training the adjudicators in Kamloops and Courtney?
A: I believe it was two days – now I could be – I could stand to be corrected on that but I believe it was a two day training session.
Q: All right – and then when you rolled out the whole system to the geographical units?
A: I believe it was the same training – it was done by the same people – I recall that – I’m sorry I’ll ask Maryanne who is here – it was four days I am sorry.
Q: Okay, now if we can turn to document –it should be tab 16 – I think you know what it looks like – is it there – it’s on your table –
A: I think Mr. Bates may have given it to me this morning.
Q: And you indicated that with the trends route you did a review – and this is part of the review correct?
A: Actually I believe what happened was that despite the fact that we were reviewing and speaking to the community fairly regularly about this issue the Panel requested a review of how the roll out had gone and in fact I recall committing to the Panel that we would do a review of the roll out to ensure that the training had been done appropriately, that we were doing follow up, reviews and we were holding people accountable for dealing with the Chapter effectively.
Q: Okay - can we turn to the second page – there’s two charts – there’s three pages here – the middle page is a chart – activity related soft tissue disorder performance – Y claims – year to date – March 1997 – and we don’t – just the first two there – Abbotsford and Burnaby –and we see the disallow rate in Abbotsford at 13.9% and in Burnaby 59.5% – pretty wide spread wouldn’t you agree?
A: Yes I would.
Q: Would that be acceptable or unacceptable in your view in – as a manager?
A: Depends on whether they made the right decision.
Q: Okay
A: We could have that kind of variability based on different industries for example in Abbotsford you have a lot of poultry processing so you should probably have a higher allow rate in that particular industry then you might somewhere else and yet here – well that really confirms that doesn’t it? There is a very high disallow rate; there’s a very low disallow rate so I don’t think you can look at disallow rates by geographic region and assume that people are doing something wrong. Having said that I should tell you that I am not satisfied with activity related soft tissue disorder adjudication across the board.
Q: Okay – I am satisfied with that – and doesn’t that go to the kind of training that was given?
A: I don’t believe it does no.
Q: All right.
A: The people in occupational diseases were decentralized into the units as a result of this initiative. So on many cases you would have the same people doing the activity related soft tissue disorder adjudication that were doing the activity related soft tissue disorder adjudication in the occupational group. So were you – are you asserting that the adjudication practices in occupational diseases were more appropriate that what’s occurring today?
Q: No - what I am saying is that we have spent a number of years training the adjudicators in occupational diseases on how to adjudicate activity related soft tissue disorder claims and now they transfer out to the geographic units and we see that training that we did in terms of running the claims through and winning the appeals – we see that as lost when we look at these figures – that’s what I’m saying.
A: I’m sorry when was the chapter signed off by Mr. MacMillan and Mr. Weir? When was the chapter 4 signed off? When you say we spent a number of years – this is a relatively new chapter and a relatively new way of adjudicating activity related soft tissue disorder claims – the whole risk factor issue was collaboratively put together by the two stakeholder communities through the occupational diseases committee. And they couldn’t have had a couple of years of experience because this chapter is relatively new.
Q: Are you saying that there is no ASTD claims and appeals prior to the new chapter 4?
A: Of course there were.
Q: That is what I am talking about.
A: The adjudication process was quite different before chapter 4 came along. Chapter 4 was intended to bring us current with mainstream, evidence based approaches to activity related soft tissue disorder adjudication.
Q: Well, I didn’t expect to get into it – but we were making that arguments that were in Chapter 4 long before they were in Chapter 4 with some success – that is what I am talking about.
A: Yes, you certainly made those points but I am not sure we were adjudicating in accordance with your views.
Q: Well, I – we’ll get into that some other time – now there is a – somehow we got into medical staff into this but two other issues in medical staff – one is - I understand there is currently a – shall we say a dispute between the Board and the orthopedic specialists in the province?
A: That’s correct.
Q: And that dispute is about what?
A: That dispute is about the negotiation of the British Columbia Medical Association agreement that was concluded this last quarter and ratified by the Board at its recent meeting. And in the discussions relative to pay-for-service arrangements for orthopedic surgeons – they put on the table an issue about their relative value process – so they had agreed within their section that their relative value fee guide would be amended and the value of an orthrocopy would go down from $300 to $200 -
Q: Was it a dispute about money?
A: They worked very hard in their negotiations with us to try and convince us that we should ignore the Medical Services Plan fee schedule and pay them the old $300 rate and we said no. and as a result of that they are now trying to engage in what most trade unions would call job action but they call something else to try to get us to pay $300 and I am saying no. I will not do that – we have one fee schedule in this province and it should apply to workers and workers' compensation as well as every other citizen.
Q: And by job action –you mean orthopods are refusing to cooperate with the Board?
A: It would be unfair to say that they are all refusing to cooperate – and there are degrees of refusal to cooperate so some of them are refusing to do surgery on clients, some of them are refusing to do consultations and others are providing us with a full array of services.
Q: I’ve heard this before – doctors are refusing to do surgery because they are on a Workers' Compensation Board claim?
A: Because – yes – because they view the $200 for the orthrocopy to be a not worthy of performing the surgery.
Q: Yes - the – we talked about nurse practitioners and the Board is in the process of – have nurse practitioners do some of the work at the Board?
A: That’s correct.
Q: And as part of that the Board is offering retirement packages to some medical advisors? Or offering retirement packages to medical advisors?
A: Yes, amongst other packages.
Q: And what is the thought of the – say ratio of nurse practitioners to doctors within a Service Delivery Location?
A: That would depend on the size of a Service Delivery Location. However, our intention is to ensure that we have one medical advisor per Service Delivery Location assisted by a nurse practitioner or perhaps two nurse practitioners, however the role of the physician and the role of the nurse are quite different.
Q: Yes and nurse practitioners would be giving opinions on files on issue such as causation?
A: They should not be venturing into that area – their primary role is to provide advice to the adjudicator on the ongoing medical – the delivery of vocational and medical services – to liaise with the physicians and other health care providers in terms of the provision of services – on the causation there is a practice directive and Dr. Blair has met with these people to explain their roles so I will refer that issue to him.
Q: Just generally – the distinctions between nurse practitioners and the medical advisors.
A: Generally, the responsibility of the nurse practitioner will be to provide clinical advice and assistance to the adjudication process – to the adjudicators should I say – and to assist with things ranging from facilitation of access to diagnostic services to things as simple as interpretation of the medical information that is before them. Some of the adjudicators have quite extensive medical training they, themselves, and others don’t necessarily. Where there are issues related to complex medical problems they will be referred off to the medical advisor – according to the judgement of the – both the claims adjudicator and the nurse advisor – this process of referring on is no different than occurs in many other health care settings where the professional individuals judge their knowledge and capability.
Q: Okay – a question on the E FILE project Mr. Buchhorn – and we are starting to see disclosure from the – based on E FILE –and I gather we heard yesterday that it is very quick – like a couple of buttons and it is – the turn around time is 48 hours or something like that - a distinct advantage to every body.
A: Yes.
Q: And as you say a distinct advantage to having – not having courier trucks running up and down the province with boxes of files and the delay and complications from that –
A: And the odd loss – yes.
Q: And I am sure that happens – I know that happens – the – however have you given any thought to what difference what EFILE would make to – not necessarily the quality of the work but the character of the work of adjudicators for example when we see the EFILE disclosures it’s not particularly scientific but the impression is that there is less information on the file – that is it’s – for example fewer telephone memos – I’m not saying people are hiding things – I’m talking about when you move to a new technology it changes the character of the work and the information you receive and it’s recorded is different and I’m just – this is often a discussion topic that the in general you would get less information from the file than you would under the old system.
A: Hopefully not less information but perhaps less material. For example if I were to dictate a letter versus do my own data entry – I might tend to be more succinct if I were having to type it.
Q: Yes.
A: As opposed to I might be more verbose if I were dictating and one of the issues that we have dealt with as a division is how can we in plain language be short, succinct and get the message across in plain language to our clients? And I think there is a tendency in most quasi-judicial organizations that the more we write the better it is. And I am not sure that is necessarily true so I think you might see thinner files in disclosure but hopefully you wouldn’t be seeing less relevant information.
Q: You can go to either extreme can’t you – you can write too much; you can write too little?
A: Yes. But I think our problem with the old paper files was that much of the material wasn’t relevant and that caused issues around disclosure as well.
Q: Yes and are your staff being trained on just the topic we are talking about?
A: As far as I know all of our staff were trained through the frame of Information and Privacy Office relative to these kinds of requirements and we are certainly cognizant of the issue that you’ve raised because in my travels through the various groups that I tend to speak to over the course of a year the labour community has raised the issue of – you know of ensuring that the technological intervention that we have all relevant material on file.
Q: Okay and you mentioned training a couple of times –I’d like to just finish it off – the - there used to be the TEC –the&ldots;
A: TEC, yes.
Q: The training education centre?
A: Yes.
Q: And that was closed down in 1993?
A: No, it was closed – I closed it and so it to have been in 1995. And the reason I closed it was that we were in a service crisis at the time and we had significant service challenges and I put every available trained adjudicator on the floor and distributed case loads accordingly and said there will be no adjudication talent in any staff position within the organization until we can improve our service. In addition to that if we had to do technical training we pulled together competent people from the floor and we would deliver the training and people would go back to adjudication desks until we got our service level to an acceptable level. So the intention was that as we moved to our new model we will create a training group that will deliver technical training but will also deliver much more than that – will integrate customer service training and a whole variety of training delivery through the technical training.
Q: Okay and it is a concern to workers because it affects the quality of the information to get their decisions and I am just looking at the Hunt Report from 1996 – and it says the closing of the training and education centre was the most obvious manifestation of a failure in a commitment to adequately develop staff talent and creativity - would you accept that comment?
A: As a short term measure – yes – there was no intention to abandon training particularly in a knowledge worker environment where I think training and development is a very important part of our business. But I was faced with the situation where workers and their families are going without wages – income continuity, benefits and would I want to have 8 trained adjudicators in the training and education centre or would I want them on the floor making sure that workers and their families are able to enjoy the benefits. So I made the decision to close it at that time with the commitment that we would move back to a significant investment in training when we clarified our new business model and that’s the point we are at today.
Q: Yes, and there is pressure on you from employers not to hire any more staff ?
A: Yes.
Q: And so currently if I am working in for example the Richmond Service Delivery Location and I get a posting or I get transferred into Occupational Diseases – what – and that happens today – what kind of formal training would I have about chapter 4 and the other things I need to know about occupational diseases?
A: If, in fact that were happening, you would be trained by a group of people that we would pull together who had knowledge of that particular area or we would provide a significant level of mentoring by competent people. So in the occupational diseases area I believe we have a half dozen adjudicators – most of them are our most senior adjudicators and they work there for a reason – that’s an area that they have a significant interest in – they tend to update themselves on current literature – they tend to be true knowledge workers in that sense and they interact very closely with the two occupational health physicians that are in that unit so that is a highly professional unit that does a lot of its own mentoring and looks after the development of its staff so we don’t have the situation in where we hire 6 people into the occupational diseases area and we have to put on a full training course that kind of thing – that would be a specialized area where your knowledge level would increase over a protracted period of time – if you were in fact a newcomer to that area.
Q: So I wouldn’t be – I wouldn’t sit down for a day and have - learn about chapter 4 and schedule B and epidemiology and things like that – I would need to pick that up from my colleagues and my mentor?
A: You – well clearly you couldn’t sit down for a day and understand all the issues in occupational diseases – you would – if you were a single individual who was assigned to that unit you would receive significant mentoring from the manager, from your colleagues – we have encouraged areas like that to sit down around a table because of the number of claims that are moving through an area like that – we should collaborate on those kinds of claims using peer knowledge and understanding.
Q: My point is this – there is no formal training and I – there’s no curriculum?
A: For the occupational diseases area? I can find that out for you – I would be surprised if there weren’t an action plan and a curriculum for training in that area.
Q: Well, yes, if you could do that and just to finish it off – there is a learning centre that the Board has and they had an exhibit of it the other day and I went over to have a look at it and– they asked me what I was interested in thinking that I was with the Board and I – I asked them – they had all their manuals out there and I said have you got anything on the Act and she said no and I said have you got anything on policy and she said no and she gave me a pamphlet and it should be at tab 15 – it’s a – and I’ll just leave that for the record.
A: Well I’d like to comment on that because you’ve made that appear as though the learning centre is our technical training area &ldots;
Q: It’s not&ldots;
A: The learning centre is an area where knowledge workers in a knowledge worker environment should be able to go and practice some skills with respect to the new technology that we are introducing and there’s a menu of the soft skills areas that we can deliver through personal computer based interactive training so to represent that as our technical training arena I think would be inappropriate.
Q: I’m making the exact same point as you – it is voluntary.
A: Good, great.
Q: Yes – just one final thing on staff – do - if I was working as an adjudicator wherever and I make decisions – is there any formal process for me to get back from the Review Board and the Appeal Division decisions on my claims?
A: There is a formal process for you to get the claims that has been overturned – a decision was made because of the significant volume issues that adjudicators are dealing with 2-3 years ago that we would only give the adjudicators the decisions that required action and wherever necessary we would give the same adjudicator the claim that had been dealt with by the Review Board to implement both from a learning and development perspective but from a consistency perspective. So as we move &ldots;.
Q: Are you saying that it would come back to me in the normal course for implementation?
A: We have a gentleman by the name of Mr. Win Stanley who reviews all Review Board decisions and he determines whether any decisions are required on the returns; they are then sent to the manager of the Service Delivery Location – the manager reviews the decision – makes a decision as to whether there is a training issue – any kind of an issue that needs to be followed up with staff – significant issues are triaged to the policy group in our division for action and for discussion in case conferencing but where it is a single decision that requires action it is referred to the manager who refers it to the adjudicator and if discussion is warranted then the manager and the adjudicator will discuss the claim and the decision from the Review Board. That is the process that is set out. Now when you have 200 people – is that process followed every time? I’m sure it isn’t but that is the formal process that is required.
Q: Now is that process to determine – is it to determine serious errors that were made or is it a training process?
A: Both.
Q: So if a review board decision and a –what about appeal division decisions?
A: Same.
Q: Okay – just a few other areas Mr. Buchhorn - I was –at the break someone pointed out to me something on the orthopedic specialists and I was wondering if there might be some clarification necessary there – as I understand it the dispute is that – the board is hiring orthopedic specialists and paying them a good rate for examining the workers at the Board and the dispute with the British Columbia Medical Association is that the orthopedic specialists in private practice so to speak – that is the ones who are not seeing patients at the Board are getting paid less is that your understanding?
A: No, that’s not my understanding – that has become a convenient issue to mask the real dispute – we hire orthopedic specialists on a sessional basis at the Board for 3 ½ to 4 hours session. The people who are seeing consultations will see 5 workers during that period &ldots;.
Q: Those are visiting specialists?
A: These are visiting specialists.. if
Q: Yes.
A: If the visiting specialists were to do these consultations in their office they would receive $200 each which is the agreed upon fee schedule – Drs. Davidson and these people that we have retained in fact will see five and will get $800 which is less than what they would receive if they were – they were in their own practice.
Q: $800 for 4 hours?
A: Yes.
Q: That is practically the same.
A: Well if you see five, so, I think that whole issue is masked in British Columbia Medical Association politics. And I think we should be careful about what the real issue is.
Q: Yes, I am sure Dr. Blair knows all about it.
A: And Dr. Blair having been a past president of the British Columbia Medical Association is advising me on this issue.
Q: I’ll stop there – Mr. Buchhorn in another matter - you - one of your graphs shows the current success rate on appeals -it was 35% - is that 1996/97 figures?
A: Right.
Q: And historically it’s been from 30-40% and recently it was as high as 50%? I think that was 1990&ldots;
A: Well when I was the deputy minister of the Ministry of Labour in the early 1990’s I recall that the allow rate was about 44%. And I think the graph showed that.
Q: Yes, historically it has been 40% and back to the mid-1980’s it’s been 40%.
A: 40% yes.
Q: Now, do you have any sense of what –if I may – you are responsible for decisions being appealed in a broad management sense
A: Yes.
Q: Do you have any sense of what percentage would be acceptable in terms of a – I’ll use the word - an effective organization – that is what - presumably it wouldn’t be zero – but I’m suggesting that 35-40% is too high –first of all would you agree with that? That 35-40% is too high?
A: I think if you were looking at this from a quality perspective that – as the quality movement would they would look at how many pieces of work came into the organization and what’s the error rate so we have 200,000 pieces of work coming into the organization that’s new – we then have a significant number of reopenings which would pile on top of that – of that 200,000 and if you had a error rate of 1% in a total quality environment I think that would be perceived to be fairly good and I suggest to you that if we’re managing 250,000 pieces of work a year which all require decisions and this is not just entitlement these are wage rate issues so the same claim could have five appealable decisions which the Review Board counts as one finding each so we have a – we have a problem in terms of organizations measuring differently. But if 2-3,000 – 2,000 of those are overturned that would be less than a 1-% error rate. Now unfortunately each of those individuals within that 1-% are aggrieved so it is a serious issue. And we take it very seriously which is why we track it the way we do – we review all returns the way we do and we really want to see if we’ve dealt with the claim appropriately relative to policy so we take that issue seriously.
Q: Well, however you measure it the workers who look at the success rate of the Review Board – never mind the Appeal Division and the Review Panel and they see that there is a one in three chance of being successful – even without – when a client comes to me that is what I tell them – without even looking at your file –and that’s – and we happen to think that our success rate is higher than that – but I am suggesting to you that that’s – that’s a – that’s a problem in the original decision making process – if the problem is in the Appeal system and I am not saying it should be zero – but when the allow rate is that high for that long a period that there is something wrong with the original decision making process.
A: The original decision making process could be improved in an organization as large as ours – I think when you appeal a decision you might have the benefit of more information because you may have – you may have on behalf of the worker gone out and solicited more information which the adjudicator may not have had an opportunity to weigh.
Q: Quite so I make the phone calls that the adjudicator didn’t make that would have allowed the claim.
A: Or you might take your client to another medical practitioner who might give another medical opinion in which then throws that issue up for the weight of evidence which then improves your potential for discretion within the system.
Q: Yes I saw the medical memo to the specialist for the worker to get an opinion from the specialist that the Review Board accepts over the medical advisor.
A: And at that particular time you might be 8 months or a year into a situation at which point there may be more medical clarity to the problem then there was on day two or one or there may be more information available about causation.
Q: So are you saying that that the system can always be improved but you are basically content with that allow rate at the Review Boards?
A: No, I didn’t say that at all.
Q: Well I’m not sure what you are saying.
A: I – you asked me in the context of most organizations how were we doing from a quality standpoint. And I answered that we were probably within the tolerance of about a 1% error rate and I prefaced that by saying I’m not happy with the quality of decision making – there is a lot of room for discretion in our organization whereas in most organizations there is very clear cut ways to do your job and do your work and so the more clear cut your business process is the lower your error rate should be.
Q: And what – if you are not happy with the 35-40% what number would you be happy with?
A: I’m not sure that I would look at it that way – I’d be looking at are our decisions consistent across the organization? When we do reviews do the exhibit a high quality – not only in terms of the decision but in the way the decision was communicated which I think is another piece of the puzzle – I’m not sure there is a number that I would pleased with but I can assure you that we can improve our decision making.
Q: Well do you care what the Review Board says about your decisions?
A: Absolutely that’s why I put in place a process whereby the manager receives every decision that has been overturned and discusses it with the adjudicator and they decide was there a policy issue here; was it the way we weighed the evidence – so they look at a number of issues and if there is a policy issue it gets referred to Mr. Pinto. Mr. Pinto sits in on case conferencing sessions that review issues that the Review Board or Appeal Division points out to us so as best we can within this traditional model we have tried to put some quality assurance process in place.
Q: All right – on just one point - the training –last night while I was watching the hockey game I was reading over the slides you presented in May of last year – and I had a question – I asked a few people from the Board and they were sort of perplexed by it – actually I’ll – Mr. Buchhorn this is Mr. Anderson’s presentation – I’d be pleased if you wanted to defer it to him – but the – but the point is under 1997 training you got 2.8 for regular training; 3.3 for strategic project and 6.1 and you say there that it’s 40%– 46% of payroll
A; I assume that is 4. – you know I am really at a disadvantage here because I didn’t prepare this material – this is Mr. Anderson’s material.
Q: Well perhaps Mr. Anderson can – if he stopped me in the hall during the week in March that would be fine –
A: I’d be happy to have him discuss this with you.
Q: Okay, on the case management model on your slides –you have the I think this is your slides - this is the third page in – you have May – December 1997 results that was the second or third busy one you talked about – and you have 2456 coming in –and you have three streams – the 1200 resolved – do you remember that one?
A: Yes.
Q: And then 186 in another stream - do we know or can we say how that is different from the previous model?
A: Yes, I covered some of the highlights in my comments about the slide. I just want to confirm that we are talking about May to December 1997 – Results?
Q: Yes.
A: The highlights for that slide I think are that the front end grouping – the client service representative and the entitlement office handle 85% of time loss claims – so what – we are hovering around a 15-17% referral under case management as opposed to as I mentioned much higher in the current model. And in fact much lower than our expectations when we initiated this strategy. The other thing that we are finding – it doesn’t reflect in this chart that 79% of the target claims reach case management within 4 weeks. So what is also working in this model is the early referral both from entitlement at the five week mark or much sooner as I mentioned in the triage rules from client service representatives. Referrals to both rehabilitation are occurring on average at 130 days versus much longer timeframe in the current model. And much stronger return to work outcomes in out of 250 final claims 136 were back to work and 9 seeking work. And I guess as Ron mentioned in his presentation we don’t have a good return to work indicator as such. We are building that into EFILE but our best indicator of return to work is as you well know is our duration statistics. The average duration of the case management claims on that side of the office in Prince George was 55 days versus the overall average for the office of 77 days. So a 22 day reduction in duration as a result of we think to a great degree our case management initiative which translates into an improved return to work outcome so I think in summary form those are the key highlights of how it is going.
Q: All right and one final point – in terms of getting – you talked about this in terms of expediting files – as I understand there is a new process in the Board that –some identifies a file as one – is it a purple file? – is one that can be – one that can be got out in 17 days?
A: I didn’t hear your reference; was it a purple file?
Q: Well I’m not sure of the colour of the code but it’s tagged in some way and it is a file that they can get out in 17 days?
A: I’m not – I’m not ringing any bells with your reference to a purple file or anything else – I think yesterday in Mr. Massing’s presentation he referred to Assured Service Guarantee and that may be the reference that you are referring to. Assured Service Guarantee being our Assured Service Guarantee which ties into our commitment in trying to achieve an entitlement decision within 17 days. So if we are not able to what we have undertaken through the auspices primarily of the client service representatives and the call centres to advise claimants that we are unable to make an entitlement decision within a timely fashion and these are the reasons why. I’m not&ldots;.
Q: All right - is there someone called an expediter now on the floor?
A: Yes, the – that’s in the entitlement office – and that is occurring in our Richmond Entitlement Group where we have established a service expediter position and there again and this comes back to piloting in a smaller form to ensure that it would benefit us in terms of expediting entitlement decisions and we’ve got I believe 5 or 6 service expediters serving approximately 30 entitlement offices and their job is really to – punch up, and go after, and expedite getting information for the decision makers in a more timely fashion so that the claim files are more decision ready for them and the relevant material is available for them for their review.
Q: And are they in part driven by the 17 day timeline – their urge to move files along and get them out in 17 days.
A: I think that’s fair to say – I think that everyone in our organization - whether they be operating in the call centre environment, in the entitlement office, in the case management – I mean there is still some entitlement activity taking place. Everyone is very clear about our approach to trying as best we can to provide entitlement decision in 17 days.
JIM SAYER:
Q: It is a very, very knowledgeable panel that the Workers' Compensation Board has provided us with today and I’m appreciate that –we are going to try to take advantage of that – the focus on some of the key issues that have aroused the anger and frustration of the injured workers and which has been expressed to the Royal Commission over their months of hearings –I think it is fair to say that the presentation of injured workers can be summed up in that the Board was – simplistically that the Board was unfair to me – and primarily that unfairness has not been – though it may be a part of it – has not been that you don’t get my cheque out in 17 days it took you 25 days or 35 days or 45 days –primarily that unfairness is that injured workers have been expressing to all of us as advocates and to the Royal Commission is that – in that you cut me off the wage loss benefits when my doctor said I wasn’t ready to go back to work; you reduced my wage rate to the point that I couldn’t pay my bills claiming that was all my earning capacity was when if I hadn’t been hurt I would be earning much more than that at work – you assessed a pension which doesn’t reflect what I’m going to lose for the rest of my life based on my injury and I haven’t heard anything in this otherwise very impressive presentation that the case management model that is going to change any of that? So I wonder if you would like to address quality in that sense as opposed to quality in terms of these quantifiable things like how quick do we get the cheques out and how quick do we return phone calls and so on.
A: I would agree with you that the issue of getting the first cheque out is only one of the issues that we struggle with in terms of providing a comprehensive service however I would not minimize that Mr. Sayre because what I tell my employees every time I have an opportunity to speak to them is that some of us that make a heck of a lot more money than an injured worker would have trouble getting through a couple of weeks without a pay cheque. And I always put it in the context of if I were to stand here in front of our staff and say we’ve got a payroll problem – we can’t get your pay cheque out this next week and it will be a couple of weeks before we can get your deposit in the bank – how many of you would be able to honestly survive that situation without being in some distress so the first issue for us is to ensure that a worker and his or her family gets a pay cheque when they are entitled to workers' compensation. Beyond that I think the case management initiative deals with some of the issues that you raise – one of the significant tensions in the system that I experienced not only in this position but in my prior involvement with workers' compensation is that tension between the attending physician and the Board. And the entire focus of the case management initiative with respect to medical services is to ensure that we put the attending physician back in the driver’s seat with respect to an appropriate clinical care plan and representing the worker’s interest from a medical perspective. Now I’d really like to defer that to Don Graham this afternoon when he’s here because he can tell you what it was like to be a Board physician in the past and what it is like to be a physician in the case management pilot. Now having said that the next issue is the issue of what kind of treatment am I going to get – I think I’ve shown you that in the past very few workers were ever given the timely and effective treatment that mainstream, evidence-based literature that says they should get particularly in the areas of soft-tissue injury but more particularly in areas like hand injuries where it is extremely important right from the acute stage to get people into effective treatment – particularly in areas like amputations and some of the more significantly traumatic claims. Now we tend to deal better as an organization with trauma claims because there is no doubt in anybody’s mind that the worker is injured. Where I think we need to get a lot better is on the diseases and the insidious type of exposure where one can’t see that traumatic injury but clearly the worker has become disabled from exposure to work of some kind so we’ve got a lot of room for improvement but the issue is to put the attending physician in the driver’s seat, work through the attending physician, don’t second guess him or her. In the area of average earnings it is interesting that this is an issue that has eluded all of us for many, many years. I remember hiring Warren Standerwick about five years ago and saying to Warren your job is to fix the average earnings issue – well here we are 5 years later and it is as convoluted as ever.
Q: Are you blaming Warren for this?
A: No I’m not intending to blame Warren. But I am intending to I guess demonstrate some of the complexity in making change in a complex system. You will probably know that we have a proposal that we made to the Panel of Administrators with respect to moving the rate review back from 8 to 13 weeks – the reason we think that’s important is that the J-curve or the recovery curve for workers diminishes significantly between 8-13 weeks and with our focus on effective treatment it becomes difficult to keep a worker motivated in a treatment program when a decision comes at 8 weeks that we are going to halve your compensation and as I understand it the 8 week rate review was implemented because of austerity and there were no good policy reasons for changing from 13 weeks to 8 weeks. Most other Boards in Canada use a 13-week rate review. So there is a whole suite of things that we would like to accomplish but as you probably know Mr. Sayre I’m already in enough trouble for the changes I’ve implemented so we may have to slow down on some of this.
Q: I don’t think you’ll get any quarrel from workers on delaying the 8 week rate review – particularly given the statistics and I’ve – do you have the binder that has been prepared for the
A: We just received it this morning if that is the one you are talking about.
Q: Yes – I know you haven’t had a chance to look at anything in it – neither has the Royal Commission – if you look at tab "H" in that binder – it is the – tab "H" is the proposal that I think you’ve just mentioned that has been sent to the stakeholders for their comments to change the timing of the 8 week rate review – now none of us are going to argue with the fact that if – with the idea of changing the timing and delaying it- especially given the statistic on the second page that the rate review results in dropping the wage rate of 40% of the workers and only increases the wage rate in less than 10% - but it struck me that – that proposal and particularly those statistics were significant for reasons that go beyond the question of the timing – doesn’t that suggest to you that the way in which the Board measures wage rates is fundamentally unfair? It isn’t reasonable to think that 40% of the workforce is working at greater than their earning capacity at the time they are injured. So why should 40% of them end up with a lower rate after the rate review whenever it takes place?
A: I’m not sure it is for us at this table to decide the fairness of either the statute or the policy – I think that’s the job of the Royal Commission. All I can say is that it is very difficult for some classes of worker to establish what their entitlement should be in the system given that they have no history of regular earnings. So I – you know I think that’s a very complex social policy issue that the Royal Commission should deal with and as per some other issues that were dealt with in previous days – the division and its employees I think would welcome some clarity in terms of the setting of wage rates.
Q: I take it from the fact that you brought this up yourself that you would agree with the observation that apparently Compensation Services staff themselves have made to you that reducing a worker’s wage rate makes them mad – makes them less cooperative with the Board – it poisons the relationship between the worker and the Board –this is what they are saying in this memo.
A: My point of view is that unless there were a rational reason for the decision to have moved the rate review from 13 to 8 weeks that particularly with the emphasis on getting every worker that we can into early and effective treatment – the last thing we need in terms of effecting motivation to succeed in treatment is a reduction in earnings half way through a treatment program – it’s very expensive – and should have good restoration of function and return to work outcomes.
Q: But you’ll agree with me that the way in which the rate is conducted –the principles that are followed you are just going to make the worker mad 5 weeks later.
A: The principles of how we establish wage rate I think requires a broad stakeholder consultation and a social policy decision and I’m not sure that I should be making comment about that.
Q: Okay - my point however is that it appears to me that the Compensation Services staff have said to you the way in which we calculate workers’ long term wage rates is causing a great deal of unhappiness and anger on the part of them to the point that they are not able to cooperate with rehabilitation and return to work plans – and unless you change the way in that that’s done that anger is going to arise whenever you do it. Isn’t that a reasonable conclusion?
A: It may arise given the expectations that a worker may have entering the system not fully understanding that there are trade offs in the system relative to social policy.
Q: So you are saying that this anger that is being referred to by the staff here is misguided on the part of&ldots;.?
A: It is very real but the issue is what are the expectations of a worker who has a very varied earnings history over the last five or ten years and who hasn’t demonstrated the ability to earn regular earnings that one would apply to with respect to the policy and if the expectations are greater than the system can deliver yes there would be anger as a result of that.
Q: And it has been reported by your staff.
A: Well, there’s not only anger by the workers there is anger by the staff about how complicated the process is of calculating wages. And the number of times that discretion is exercised as – by the appellate groups relative to the establishment of wages because the policy isn’t that clear.
Q: All right - turning to another broad area that has come up before in previous days this week – there’s the whole issue of policy has arisen several times and I think it has left all of us feeling a little bit confused and it is as to just exactly what sort of creature this is – there have been discussions that the difference between policy and practice and in the background there is always the distinction between policy and the law – now as the head of Compensation Services can you tell us what training or what understanding you want your claims manager or case managers or your claims adjudicators to have regarding what policy is and just how far it is applies – how far your discretion goes to go do something that is not within policy?
A: I want every employee of the Workers' Compensation Board to abide by law and policy – very clearly that’s the objective that I think all of us should have relative to the system -–now when the Board of Governors made the Green Book here – the policy book – policy – I think what happens was that the history of guidelines and instructions to adjudication staff based on precedent became enshrined in policy such that we lost the ability to really issue the kind of instructions and directives to staff in a responsive way to Review Board and Appeal Division decisions. So every word in this policy manual – even if it is misspelled – has to go to the Governors under the current scheme to be changed. Now having said that let me tell you about an even greater problem. When I came to the Board under the Board of Governance structure there was a point of view that the Appeal Division decisions were decisions of the Board and they had to be followed by the Board. Now you heard Mr. Cott earlier this week say that that was not the point of view of the Panel of Administrators - that in fact the Appeal Division decisions particularly where they talked about policy unlawful or inappropriate should go out to broad public consultation and then the policy should be changed to incorporate the views of the public. That is very different than when I was operating under the Board of Governors – Mr. Dorsey and the General Counsel of the Board were pretty specific about the fact that if the Appeal Division made a decision that this policy was unlawful that we were to abide by the Appeal Division decision. Now you can imagine if I am operating under two points of view from the Panel of Administrators and the Board of Governors that the staff would have some difficulty with respect to that so you know there needs to be and I’d urge the Royal Commission to look at this and clarify this. I even went down and spoke with Don Munroe who put this framework together and said can you give me some guidance on what you intended relative to decisions of the Appeal Division and where the Appeal Division says that the visual acuity policy is unlawful – or that the policy of paying workers – not paying workers when they are incarcerated is unlawful – so there is some genuine confusion about what is law and what is policy.
Q: Well, don’t leave us hanging what did Don Munroe answer?
A: He said you have an interesting problem.
Q: Pay me my fee and I’ll tell you what I think about it.
A: I think Don’s view was that – was that the Appeal Commissioner was brought into the system in the way that that position was to ensure that those kinds of decisions could be worked within the system in terms of changing policy and that we wouldn’t have the prior situation of the administration judicially reviewing decisions of the Commission which would look quite ridiculous from an organizational perspective.
Q: Okay - I want to go back a bit on the comments you made that I wasn’t aware of – are you saying that the Panel made a decision changing the previous practice in saying to the Board effectively we don’t want you to follow what the Appeal Division interprets the law to be until we’ve changed the policy?
A: No, I think what you heard from the Panel of Administrators that where the Appeal Division alerts the administration or the system that there is a problem with law or policy that the Panel of Administrators wishes to go out and broadly consult the stakeholders and change the policy not necessarily the way the Appeal Division may have seen the change being required but in a way that met with public policy. So that is a departure from the way the Board of Governors viewed that issue.
Q: Okay, well let’s be a little more - let’s pick some nice concrete examples –so that it is a little easier for everyone to understand it - tab "K" of the binder that I’ve given you is a decision of the Appeal Division – it’s the second one actually – I was involved in an earlier case a couple of years before that in which the Appeal Division decided that the policy that says some benefits at least payable to a worker who is imprisoned cannot be lawfully be cancelled –now the policy says they must be cancelled unless there are dependents eligible to receive them – the Appeal Division said that they can’t be cancelled unless they are things that are tied to employment such as a loss of earnings pension – and they suggested that there would be a distinction between a loss of earnings pension and a functional pension – functional pensions are payable no matter what the worker is doing even if they are retired or on a permanent holiday somewhere – loss of earnings pensions are payable as a measurement of what they are losing because they can’t work or they can’t work as productively so it did seem that that was a reasonable distinction – but that issue really hasn’t been finally decided yet. But that was a decision back in the earlier decision of 1993 that between the Review Board and the Appeal Division in the case that I was involved in they decided first of all that pensions could not be cancelled when a worker was on day parole – the Review Board decided that and Appeal Division upheld it and secondly that the functional pension – the 23.1 pension could not be cancelled because as I said that’s not tied to actual work activity on the part of the worker – we have been told consistently since those decisions were made that they only apply to the workers who appealed them and other workers have been told that their pensions will continue to be cancelled because the policy hasn’t been changed. Now the Appeal Division decided that something was illegal and the Board continues to say that we are going to continue doing it – is that something that the Panel of Administrators decided – is that the situation that the Panel of Administrators decided should exist until they got around to making a firm change in the policy?
A: I think that