Royal Commission on Workers' Compensation in BC
March 4 Full Day Session
Name: Julie Wakelin
Title: Director, Vocational Rehabilitation
Affiliation: Workers' Compensation Board
Staff Present: TR, GG, OE, GS, SN, PL
Notetaker: Steven Noble
Date: Wednesday, March 4, 1998
GENERAL COMMENTS
- MAIN TOPIC: VOCATIONAL REHABILITATION
- Subtopics: Extent of Services
- Worker Role in Plan
- Employer/Physician Roles
- Return to work arrangements
- Use of third parties
- Statutory right to rehabilitation
- Statutory Right to Re-employment
- Vocational Rehabilitation in case management
- PRESENT RESOURCE PEOPLE: Ron Buchhorn, Vice President, Rehabilitation & Compensation Services Divisions; Chris Hartmann, Senior Manager, Vocational Rehabilitation; Louise Logan, Assistant Director General, Policy & Regulation Development Bureau; Tom Kemsley, Policy Director
PRESENTATION
The Vocational Rehabilitation Services Department of the Workers' Compensation Board is pleased that vocational rehabilitation issues are considered by the Royal Commission to be of sufficient importance that the topic warrants this full day of presentation and discussion. We are ready to outline to you our current initiatives and challenges and to share with you our vision for the delivery of effective, quality vocational rehabilitation services that will serve the needs and meet the needs of all our partners and stakeholders now and in the future.
[introduced resource people; please see general comments section above]
First of all let me refer you to the overhead to the topic areas that you have identified for discussion today. We will be covering these topics in the time allocated to us for presentation this morning.
The vocational rehabilitation services in all public and private sector jurisdictions have come under intense scrutiny over the last few years. The reasons are self-evident. In an environment increasingly focused on quality of service, outcomes, client satisfaction and the bottom line vocational rehabilitation services have been presented with an evaluation challenge.
Vocational rehabilitation has a complex mission and it can be difficult to evaluate services, which we believe them to be of value may not lend themselves easily to measurement. Are vocational rehabilitation services cost effective? Are they provided at the right time and to the right people? Are services consistently delivered? Are they of high quality?
We maintain that both qualitative and quantitative measures are often used to measure vocational rehabilitation services effectiveness. We believe that an organization must weight the effectiveness of its operations and plan for future improvement. We also believe that professionals are, as much obliged to know about the effectiveness of the services of its department or agency, as they are to assess the services of outside resources. We therefore welcome this scrutiny and have in fact imposed much of the scrutiny upon ourselves in our desire to improve the effectiveness of vocational rehabilitation processes and the quality of our outcomes.
The Workers' Compensation Board provides vocational rehabilitation services to injured workers and workers’ dependents. The authority to provide these services is found in Section 16 of the Workers' Compensation Act. The provision of vocational rehabilitation under Section 16 is discretionary and is covered by published policies found in Chapter 11 of Rehabilitation Services and Claims Manual. Chapter 11 was rewritten in 1992 to include a definition of quality rehabilitation and the listing of 7 tenets or guiding principles of quality vocational rehabilitation. The rewrite did not change policy but it did bring focus to the underlying values and expectations, which professionalize vocational rehabilitation for both the provider and the recipient.
What is rehabilitation? The classical definition of rehabilitation adopted internationally comes from the National Council on Rehabilitation in the United States. It defines rehabilitation as the restoration of the disabled to the fullest physical, mental, social, vocational and economic usefulness they are capable. Within that broad definition vocational rehabilitation is defined as the continuance and coordinated process of rehabilitation which involves the provision of those vocational services designed to enable a disabled person to secure and retain suitable employment. Underlying both the broad-based definition to total rehabilitation and the specialty of vocational rehabilitation are the principles of independency and productivity. Principles which are deeply ingrained in vocational rehabilitation practice and which when integrated into vocational rehabilitation services provide the best overall results for clients.
Vocational rehabilitation then is more than an outcome or series of outcomes. It is a process. A process through which disabled persons are enabled to mobilize their own resources, decide their life direction, and achieve goals through their own efforts. The vocational rehabilitation professional is a catalyst, coordinator, and guide within that process.
The vocational rehabilitation services department is part of the Compensation Services Division. As director I report to the Vice President, Ron Buchhorn. The department is organized in a decentralized, clinical supervision model. The 85 vocational rehabilitation consultants are administratively connected to their respective Service Delivery Location or area office. For technical vocational rehabilitation support and professional guidance they report to a first line clinical supervisor, who in turn reports to a Senior Vocational Rehabilitation Manager. This clinical supervision model commits a high level of technical supervision, ongoing training, and quality assurance. The ratio of vocational rehabilitation consultants to managers has been reduced in order to optimize clinical oversight which is critical to the provision of quality vocational rehabilitation services. I would also point out that in recognition of the importance of program development, evaluation, research, training, and professional development we have a research and development section comprised of two senior vocational rehabilitation consultants and support staff. Inadequate and insufficient data availability, collection, and analysis to enable an appropriate level of reporting on key performance indicators has been an ongoing source of frustration within the department. Until 1989 almost all of our data collection systems were manually based and were only minimally improved in 1989 and 1996. In 1996 we introduced our current statistical tracking system. The Rehabilitation Performance Management System. As a consequence much of the data that you are about to see represents only very recent activity. Information from our mainframe system was available from previous years and wherever possible has been incorporated into this presentation. Requests for vocational rehabilitation services comes from a variety of sources including claim adjudicators, medical practitioners, union representatives, advocates, and from injured workers themselves. Upon referral the vocational rehabilitation consultant determines the eligibility for services and then determines the nature and extent of the services to be provided. In 1997 the department received 6,731 new referrals. Referrals have continued to show a downward trend since 1994. There are several reasons for the decrease in referrals to the department. Overall, claims volumes are down and we would expect to see a corresponding decrease in vocational rehabilitation referrals. Another factor impacting referrals is the introduction of earlier and more effective clinical treatments with the continuum of care. This has diminished the number of soft tissue, chronic pain clients who would have become vocational rehabilitation cases. And lastly the department introduced a formalized referral system internally based on established referral guidelines. And while this initiative has not completely eliminated all inappropriate referrals it has had an impact on referral numbers.
One of the measures of vocational rehabilitation service effectiveness is return to work outcomes achieved. Although referrals are down service effectiveness is improving in the area of return to work which is the primary service goal of the department. 2,451 injured workers will return to employment with vocational rehabilitation intervention in 1997. There is a steady upward trend in return to work outcomes which perhaps indicates that with fewer referrals we have reached a stage where the inventory of work or case load size for each vocational rehabilitation consultant allows them to provide more timely and comprehensive services which translates into better and more durable placements for injured workers.
With return to work as a stated corporate and departmental goal vocational rehabilitation consultants turn their attention to trying to achieve the best placement for each worker. The very best placement of course is with the accident employer. The vocational rehabilitation consultants offer their expertise on job accommodation, and modified or transitional employment in an effort to help the injured worker maintain their attachment to their employer. We know that this connection is a vital one but once interrupted can result in injured workers drifting into a disability pattern that is almost impossible to break. Empirical evidence tells us that after only 6 months of work related disability the chances of an individual returning to employment are only 50%. After one year this decreases to 25% and after two years it is close to 0. This graph indicates that the more successful placements are occurring at the accident employer’s workplace and that fewer returns to work come as a result of formal training or self-employment. In 1997 they’re 6,731 referrals to the department and 6,857 cases were closed reflecting the mixture of closures of new referrals and old inventory. Not all of the cases referred to the vocational rehabilitation consultant are referred with return to work as an expected outcome. Other services are provided by the department and these will be discussed a little later in the presentation. We are able to statistically track the percentage of new referrals which are referred with return to work as a stated outcome. In 1997 almost 50% of the closures involved cases where return to work was not the stated goal or outcome expected. Of the 3,473 cases closed in 1997 where return to work was an expected outcome – 70.6% were successful. Of the remaining 1,022 cases where return to work was not achieved 567 clients were not looking for employment and had become voluntarily inactive for reasons such as retirement, or noncompensable injury or disease. The remaining 455 clients can perhaps be categorized as rehabilitation failures. And we need to do some more analysis to determine the reasons for a non-return to work outcome in these cases. In 1997 the vocational rehabilitation consultants closed 3,384 cases where return to work was not an expected outcome. This group of closures include 1,202 files which were either transferred out or came in as inappropriate referrals. Another 2182 of these files involved vocational rehabilitation assistance or interventions such as injury adjustment or crisis counselling, home care services, assessment for personal care and/or independence and home maintenance support, commutation investigations and employability assessment. By capturing this data along with return to work outcomes we are able to credit the vocational rehabilitation consultants for their full scope of practice and for their important services which they provide under our current model at the Board. We anticipate that some of our initiatives such as case management will result in a redistribution of some of these activities to other members of the case management team. There has been some consternation within the community with respect to the pattern of vocational rehabilitation expenditures over the last 6 or 7 years. Expenditure patterns since 1986 show a period of modest growth from 1986 to 1990. Followed by a period of great acceleration in expenditures in 1991 through 1994. In 1994 the Board spent $68.6 million on vocational rehabilitation services. This figure represented an alarming annual rate of increase from 1991 when $20.4 million was spent. And this increase came during the period when new referrals decreased from 11,700 in 1991 to 8,700 in 1994 and where corresponding increases of successful outcomes could not be shown. In 1995 with the reconstitution of the Vocational Rehabilitation Services Department which had been dissolved in 1993 the expenditures started to decline. In 1996 vocational rehabilitation expenditures totaled $43.4 million and in 1997 expenditures came in at $42.3 million. This decline has been categorized by some as a cost continuum exercise initiated at the expense of injured workers. We reject that argument.
The clinical supervision model which was put in place since 1995 has resulted in more timely, consistent and effective vocational rehabilitation interventions and has eliminated much of the unproductive or down time where injured workers were stuck in the disability continuum making little or no progress toward either return to work or non return to work goals. You may also be interested to know that we spent more per referral in 1997 $6,289 than we did in 1993 - $5,338. However we would maintain that a measurement of dollars spent per referral or client may not the best measure of service effectiveness. And that quality rehabilitation is not directly correlated with expenditure. Client outcome measures must be factored into overall vocational rehabilitation program evaluation to assess services. We want to know if our vocational rehabilitation clients are satisfied with the help given to them through the Vocational Rehabilitation Services Department and we want to know which services have been the most effective and the least effective for our clients.
In late 1996 the Angus Reid Group conducted a client service survey specific to vocational rehabilitation services at the Board. The survey was initiated in response to criticism from the community and was designed to examine both service and program issues. Both injured workers and employers were surveyed. In an earlier presentation – a couple of weeks ago – we saw some of the division’s client satisfaction results which had improved from a benchmark of 7.2 to the most recent results of 8.3. The vocational rehabilitation survey used the same measurement scale and the results I’m sorry to report were only 4.5 at the time of our survey. Some of the concerns which were identified in the survey were communication based. These surveys stated that the vocational rehabilitation consultants needed to be more accessible, provide more emotional support, show more sensitivity, care and concern, provide workers with more information, and spend more time in the workplace instead of in the office. The results of the survey were discussed with every manager and every vocational rehabilitation consultant when one of the senior managers and I visited each office in the province during 1997. Surveying of our clients including employers will be an ongoing process through our program evaluation and research unit. The quality of increasing employment for individuals with disabilities is first and foremost a perception in the consumers’ eyes. Increased levels of consumer satisfaction with Vocational Rehabilitation Services best represents one measure of the implementation of both the spirit and letter of our important mandate. Many of you will be familiar with the administrative inventory process that has taken place at the Board and which has resulted in a number of comprehensive reviews of all Board’s services. In the middle of 1997 the Board received an administrative inventory update report from the Upjohn Institute for Employment Research. Entitled "Vocational Rehabilitation – the Policy and Practice at the Workers' Compensation Board of BC" the report was a follow up study to the full administrative inventory which had been conducted in 1995. The 1995 inventory found some very serious problems with vocational rehabilitation service delivery. In terms of inconsistency of practice, lack of appropriate management controls, and virtually no staff development activities. Because the vocational rehabilitation services department had only been reconstituted in June of 1995 – the 1995 administrative inventory could only report retrospectively. But it did acknowledge that the dissolution of the department in 1993 contributed greatly to the general loss of focus and morale, a significant and sustained increase in spending patterns, and an overall decline in the quality and accountability of vocational rehabilitation services. The update report of July 1997 – indicates that the review and analysis conducted led the researchers to the conclusion that the reorganization of the vocational rehabilitation services department at the Workers' Compensation Board in 1995 had been successful. In an open feedback session in June of last year Dr. Alan Hunt, one of the principal authors rated Vocational Rehabilitation Services at the BC – Workers' Compensation Board as an 8 out of 10 compared with other jurisdictions across North America and elsewhere in the world. However, he also stated that while much has been accomplished between June of 1995 and June of 1997 it is only a beginning step in establishing more consistent and effective vocational rehabilitation services. We agree that much more needs to be done in order to consolidate and optimize our services and that a number of challenges will need to be addressed. We need to restore community and client confidence in vocational rehabilitation practice and services. The challenge in restoring confidence is to ensure that our underlying philosophy which is client centred and collaborative in nature is embedded in day to day practice and communication. We need to built on the significant changes in key operational areas which have been made to date such as the development of clear guidelines, expectations, standards of practice, redesigning and upgrading the statistical reporting systems, and in-service professional development and training. We must improve our program evaluation to assess ongoing; the delivery impacts and costs associated with the provision of vocational rehabilitation services. In order to provide the highest quality of vocational rehabilitation interventions our staff must be equipped with the necessary tools of the trade and efforts must be focused on technology support. We must also increase our efforts to enhance community-based service capacity through the development of external provider networks and partnerships with key agencies and groups. And we must identify and initiate and support research efforts that will contribute to vocational rehabilitation policy and practice in the Canadian context. In order to address these challenges and to improve service effectiveness we need to develop a process of community consultation and review to foster respected and productive working relationships to help us meet our mutual goals. We are committed to successfully meeting all of these challenges and in so doing achieve operational excellence in vocational rehabilitation at the Workers' Compensation Board of BC.
In order to meet its objectives the Vocational Rehabilitation Services Department provides a wide range of services to injured workers and in cases involving fatal injury to dependents. These services include counselling, vocational assessment and planning, job readiness and skill development, placement assistance and residual employability assessment. Rehabilitation assistance may be provided in cases where it appears to the vocational rehabilitation consultant that such assistance may be of value and where a decision has been made that the injury, occupational disease, or death is compensable. The vocational rehabilitation consultant determines the worker’s eligibility for assistance in reference to Section 16 of the Act and by referring to the guidelines developed by the department and published in the department’s procedure handbook. Although there are no hard and fast rules to which the vocational rehabilitation consultant can refer there are accepted practices which guide the discretionary entitlement determination. The procedure handbook lists 7 scenarios which outline some of circumstances which would warrant vocational rehabilitation assistance. In making an eligibility determination the vocational rehabilitation consultant considers the departmental service objectives as outlined in policy. These objectives are: to assist workers in their efforts to return to their pre-injury employment; or to an occupation category comparable in terms of earnings capacity to the pre-injury occupation; to to provide the assistance considered reasonably necessary to overcome the immediate and long term vocational impact of the compensable injury, occupational disease, or fatality; to provide reassurance, encouragement, and counselling to help the worker maintain a positive outlook and remain motivated toward future, economic and social capability. It is not the mandate nor is it the responsibility of the Board’s Vocational Rehabilitation Service Department to assist workers to change occupations simply because they want to or because they have a poor relationship with their employer. Nor is it appropriate to support a new vocational rehabilitation goal that may far exceed what is reasonably required to offset the effects of injury. Assistance is provided to the overcome handicaps resulting from workplace injury or disease. Eligibility determination as a critical function of the practitioner requires considerable professional competency. The vocational rehabilitation consultant must look at many factors in coming to an eligibility decision and ultimately must determine the worker’s injury has in some way placed a barrier or barriers in the way of re-employment or social reintegration. In all instances of eligibility or ineligibility the client must be notified officially and the decision recorded. Good professional practice also requires that the practitioner to convey important information of this nature to the client in a personal communication. For ease of discussion the types of vocational rehabilitation assistance available to injured workers can be divided into two categories: benefit payments and rehabilitation services. Benefit payments are either in the form of wage replacement or in some cases wage top up or other financial expenditures which support a particular rehabilitation plan. In order to properly administer and track benefit payments they are coded in the automated wage loss system. The vocational rehabilitation consultant enters a budget on to the system as part of the rehabilitation plan using the appropriate code. There are currently 6 codes which are wage loss equivalency and 7 codes for the balance of financial expenditures. There are also several codes which are used exclusively by health care benefits, for house and vehicle modifications for seriously disabled clients but since 1994 these have not been reported as vocational rehabilitation expenditures. The wage loss equivalency codes are as you see them on the overhead – Code E.- job search allowance is used when clients are actively seeking work; Code G – for formal training when clients are in a retraining program; Code H – for work assessment; normally when clients are trying out a job to make sure it is physically suitable; Code R – or income continuity which is used as a bridging benefit to pension; Code U- rehabilitation assistance which is a relatively new code used for planning purposes; and Code Y – which is training on the job and in this case it may be a partial wage loss or a top up as employers normally cost share training on the job arrangements with us.
The non-wage loss equivalency codes are Code F – for subsistence and that may be paid while the client is away from their home for training or job search purposes; Code J – which covers course fees, books and supplies; Code K – for travel either for training or job search purposes; Code M – miscellaneous, for example a computer purchase to enhance or support a rehabilitation plan; Code N – for homemaker and we’ve heard a little bit about this the other day – for child care, child minding services; Code S – self-employment through business start up and which is a relatively new code and; Code T – for third party contract, normally for individualized assistance for clients.
As earlier noted total expenditures involve 13 codes; for 1997 was $42.3 million including approximately $1.2 for business start-ups, $8.7 million in job search allowances and $13.3 million in rehabilitation planning. Code R – income continuity expenditures – have decreased significantly since 1995. And we do understand that this issue along with a departmental practice change is generating considerable debate. Perhaps this is an appropriate time to speak to the Code R issue which will no doubt be raised for further questions during the question period. In order to understand the practice change in Code R it is necessary to understand a little of the historical context. Code R, or income continuity benefits, have been paid to injured workers since the implementation of the Reporter decision 320 in 1980. These benefits were implemented in order to bridge the gap between determination of wage loss benefits under Section 29 or Section 30 of the Act and the commencement of the worker’s permanent partial disability pension. The rationale was the delays in assessing the pension which "is almost due to the fact that it is difficult to make a quick estimate on the permanent impact on the worker’s employability." The Decision 320 became policy under number 89.11 in the Rehabilitation Services and Claims Manual with responsibility for the issuance of these payments given to the vocational rehabilitation consultants. The proper administration of Code R benefits has been a contentious matter for many years. And was raised as an issue of major concern in a Code R audit completed in 1992.
One of the points made by the internal auditor was as follows, " it does not appear equitable that claimants in receipt of Code R are generally better compensated for periods of time following the termination of wage loss benefits and claimants’ pensions are quickly established. As such the Compensation Services management should consider if it would be more equitable to base Code R rates on the estimate of future benefits rather than on the claimant’s wage loss rate. The discretion to vary or adjust rates is included in policy." In addition to internal audit concerns management was also concerned about the indiscriminate use of Code R benefits by the vocational rehabilitation consultants. Much of the Code R expenditure was not applied to service but rather it was applied to waiting periods – waiting for job search, waiting for training, and mostly waiting for the client and the rehabilitation consultant to put a plan together. Code R was often the code of choice to cover these waiting periods. It had administrative convenience because the code was time based and does not show up on a vocational rehabilitation budget. Instead of providing a timely intervention or undertaking the needed assessment the vocational rehabilitation consultant was tempted to park clients on Code R where they could sit for extended periods of time.
Employability assessments and pension implementation were therefore delayed beyond what could be considered reasonable timeframes. Management knew of the problems with Code R – problems which were confirmed when the department undertook a special employability assessment project to clear up this huge backlog. That project revealed a consistently inappropriate use of Code R and the resulting vocational rehabilitation failures and lack of timely intervention. In 1995 management set out to try to address both their own and internal audit concerns about Code R. And in September 1996, the department initiated a practice change. This practice change was written into the procedure handbook and it instructs the vocational rehabilitation consultant to complete an employability assessment prior to implementing Code R benefits and to pay benefits at a wage which reflects the conclusions of the employability assessment. What this means is that many clients who would not in past practice have had timely vocational rehabilitation intervention now would. And only those clients who met the criteria for Code R payments would be placed on this bridging benefit. I must emphasize that clients are not being abandoned at the time of medical when their Section 29 or Section 30 benefits have concluded. In cases where vocational rehabilitation mandate has been established planning is usually the first step, and clients are placed rehabilitation benefits under Code U. Once planning is established other wage loss equivalency codes will apply. Code R applies when the worker becomes ineligible for any other code. The matter has become a pension issue at that point and vocational rehabilitation interventions have in essence ended. Perhaps an example would help to illustrate the application of Code R benefits. It is a rather busy slide but what you see in front of you are two out of what could be many examples of clients who go though the vocational rehabilitation process. In this case a worker is a 55-year-old mill worker following recovery, medically plateaued when Section 29 benefits conclude. The worker’s knee injury has left him with a permanent disability which prevents him from returning to his pre-injury employment. There is no alternate work available with the injury employer. The worker has been referred to vocational rehabilitation services for planning and ultimately for employability assessment. At the point of referral the vocational rehabilitation consultant places the worker on Code e benefits while conducting an initial assessment and commencing planning for a return to work. The worker initiates a desire to return to employment and both he and the vocational rehabilitation consultant identify a number of occupations that would be both physically suitable for the worker and would also be reasonably available to him. The job search commences and the worker is switched to code e benefits. While job searching the worker learns that his application for Canada Pension Plan disability benefits has been accepted. And he also learns that he is eligible for an early pension from his employer. He tells the vocational rehabilitation consultant that he has decided to take his early retirement and to end his job search. The vocational rehabilitation consultant must now complete the employability assessment which concludes and although the worker will suffer a long-term loss of earnings based on his profile he is capable of employment at a wage rate below his pre-injury earnings. The consultant places the worker on code R once the employability assessment is completed and sends a copy to the worker who has 30 days in which to submit a response if desired to the claims adjudicator in the disability awards department.
The pension will not be implemented until that 30 day waiting period has expired. In accordance with current practice the consultant changes the worker’s benefit rate upon conclusion of the employability assessment. We are now asking for a policy change to defer this adjustment in benefit level until the 30-day waiting period has elapsed. This and two other changes are currently before the Panel of Administrators. We have identified the total number of individuals affected by the Code R practice change during the 12 month period September 1996 to August 1997. Of the 450 clients who received a code R payment during this time period we estimate that only 10-15% had their benefit levels adjusted in accordance with the practice change. But the only way to get a completely accurate accounting of what happened and why is to do a manual file audit. And we are in the process of auditing all 450 files to prepare accurate data as the Panel of Administrators will be reviewing the information again in April. One other factor impacting on the reduction in Code R payments relates to recoveries. Pensions rebates to the Vocational Rehabilitation Services Department - dollars spent on Code R up to the pension level prior to pension implementation. Although statistics will show a negative net expenditure level in Code R we are still paying out Code R benefits. And in 1997 we paid out $3.2 million. With Code R payments now brought under control we believe expenditures will approximate a break-even basis for the indefinite future which is where they should be from a cost accounting point of view. Benefit payments and other expenditures are made as part of the vocational rehabilitation planning process are to support and facilitate the successful completion of a rehabilitation plan.
A wide range of assistance is offered to injured workers in the rehabilitation process – assistance available includes supportive counselling, job search/career redirection/job clubs, graduated return to work, work assessment, modified employment, worksite modifications (tools, equipment, ergonomic changes), training on the job, formal training, and self employment and business start ups. The vocational rehabilitation consultant assesses the worker’s employment barriers and develops the appropriate interventions that will lead to the optimum result. In order for this process to be effective it must be a collaborative one in which all of the rehabilitation team participates in facilitating the client’s choices. Assessments which are properly done are comprehensive, cost-efficient, and effective. The vocational rehabilitation consultant is constantly confronted with the heavy burdens that can be thrust upon an individual’s life. Facing a multitude of problems wrought by disability in the life of a client demands that the vocational rehabilitation practitioner have a true understanding of both their role and responsibilities and also be able to communicate to their client the client’s role and responsibilities in the vocational rehabilitation process. I spoke earlier of two principles underlying the profession and the practice of vocational rehabilitation – those of independency and productivity.
Vocational Rehabilitation Consultants through their interventions and counselling support attempt to assist injured workers to adjust to their injuries and disabilities and to regain productive lives. Sometimes we are criticized for urging workers to move through the adjustment period too quickly. And sometimes we are criticized when we tell workers that they are employable or able to enter and retain employment consistent with their capacities and abilities. When adults become disabled by a work accident and injury they are separated from their work routine and as patients they may lose their productive orientation in an environment that leads them to accept assistance. Prolonged disablement without a planned work program may render individuals unable to fulfill a work role.
One of the roles of the vocational rehabilitation consultant is to assist the worker to maintain a work focus through the injury adjustment period. That is the counselling role. The vocational rehabilitation consultant also has a coordinating role and in this role the consultant creates a link between the often-isolated world of the disabled client and their community - between their capabilities and their opportunities. They help clients accept and minimize their disabilities – to acknowledge their assets and limitations and to prepare them for the fullest lives they can lead. Vocational rehabilitation uses all of the relevant resources both within the disabled individual and within the community. Disabled individuals usually cannot utilized these resources themselves and sometimes do not know that they even exist. It is the vocational rehabilitation consultant who helps clients to identify, select, and obtain needed services and to develop a plan of action with realistic goals. The role of the worker in the vocational rehabilitation process is critical. The seven principles of vocational rehabilitation outlined in policy speak to the need of the workers to take an active interest and initiative in their own rehabilitation. The highly complicated nature of motivation is recognized. Clients sometimes fail to work towards goals because they are apprehensive or anxious about taking a chance or there may be external forces dominating a client’s life. Regardless of the reasons for lack of involvement and motivation the vocational rehabilitation consultant must analyze and appraise the dynamics of the client’s motivation in an effort to strengthen positive influences and decrease negative ones. Other key players in the rehabilitation process include the employer, physician, and where applicable, unions. Quite simply the process is not going to be effective without the active participation of all players. One of the major frustrations vocational rehabilitation consultants face is trying to work with a client when some of these other key players may be providing input which is counter productive to the process or at the very worst may have a sabotaging effect upon the vocational rehabilitation planning – an ultimate goal. Physicians need to understand that the worst thing for many of their patients is to be inactive. They need to work as part of the return to work and rehabilitation team as do employers and union representatives. With the full cooperation and support of all of those individuals successful vocational rehabilitation outcomes will result. A vocational self-concept is but one aspect of the full self-concept. People work to earn a living, to maintain effective human relations and for satisfaction that work itself brings. The loss of the worker role through injury and disability can lead to psychosocial dysfunction. It is therefore imperative that return to work be seen as a desirable outcome in almost every case of workplace injury or disease. Achieving a successful return to work outcome requires the involvement of not only the worker and vocational rehabilitation consultant but most importantly the employer and the employer community. Wherever possible the vocational rehabilitation consultant is going to seek a return to work with the pre-injury employer. Unfortunately most employers in this province do not have an established return to work system in place. This in essence means that some employers take their injured workers back some of the time. Some employers take their injured workers back most of the time but some never take their injured workers back at all. And only a handful do it correctly. We advocate for and encourage employers to develop and implement disability management programs that have strong prevention, return to work, and case management components.
What is disability management? Simply put - it involves the use of services, people and materials to minimize the impact and cost of disability to employers, and their employees. And encourages a return to work for employees with disabilities. It is an active and proactive process that enables labour and management to assume joint responsibility for safe return to work programs in order to successfully manages the consequences of illness, injury and disease. Disability management programs are typically designed to protect the employability of workers with the added feature of saving costs. There are many different models that produce good results. The most effective disability management programs are those which are tailor made for a specific work site. Terms such as graduated return to work, light duties, modified duties and transitional employment are familiar to those involved in return to work negotiations. Each of these programs has a different goal, methods, administrative challenges and problems. The goal of any return to work program should be to transition workers back into the situation where they can perform their old jobs with or without a reasonable accommodation. Where program goals as in traditional light duty programs are open ended and sometimes not attainable success is unlikely.
The vocational rehabilitation consultant in collaboration with the client, physician, employer and where applicable the union must determine the best course of Acton. One that will result in a successful and durable return to work. There are also major demographic and labour market forces which greatly impact on the return to work process. In a climate of shifting and declining industries and with an aging population achieving successful returns to work are becoming increasingly challenging. These changes in the job market are making it more difficult to locate suitable employment for injured workers. This fact alone makes it more critical to optimize the worker’s opportunities with the injury employer. With respect to aging workers who may present other challenges such limited education and limited transferable skills further disincentives for early return to work and positive employment outcomes are present. So we must double and redouble our efforts with employers to both save the initial attachment with the accident employer and to develop job opportunities with other employers in all communities across the province. At this time I would like to turn over the podium to Chris Hartmann – Senior Vocational Rehabilitation Manager – who will speak to you on the other remaining topics.
CHRISS HARTMANN
Vocational Rehabilitation Consultants being a wealth of knowledge, skills and experience to their positions. There are, however, where specialized resources and services are required that a consultant is not able to provide directly. This may be the result of a lack of expertise in a certain area or the inability to spend extensive time with an individual client. While some of these services may be secured within the Board for example both functional evaluations and vocational testing others may require us to use resources from within the community. Each referral to a service provider is made via a vocational rehabilitation consultant and is based on the individual needs of the worker. Most referrals to external providers require a preapproval from a manager. When purchasing services from a provider a contract is drawn up outlining the service expectations and the fees that will be paid. Progress and summary reports are submitted to the vocational rehabilitation consultant for review and continued management. In the Vocational Rehabilitation Services Department all costs associated with external service providers are monitored. In 1997 we contracted with 147 different service providers at a total cost of $1.3 million. These services are broken down into the following major categories: functional capacity evaluations - $610,000 – this figure also includes the Board’s internal functional evaluation unit; 1 on 1 placement services - $373,000; vocational testing in the community - $109,000; job search and job finding clubs $104,000; training/tutoring – this would be not the formal tuition type but perhaps life skills training or tutoring to add skills to an individual - $63,000; and we spent $62,000 on business feasibility studies for self employment. These numbers are approximate as often providers offer services in multiple categories at the same time. It should be noted that some services in the community are available at no cost to the Board or to the worker. As of today the department has established a network of external preferred providers for job finding clubs throughout the province and currently we have 13 agencies approved to provide this service. All preferred providers deliver a model currently accepted as the standard in the vocational rehabilitation profession. The providers will be submitting data on a regular basis summarizing outcomes. The most important being durable return to work which is measured as suitable work sustained for three months following the conclusion of the program. Client satisfaction will be polled for each program. The department has also begun the process of establishing a network of preferred service providers for other vocational rehabilitation services such as one to one placement and business feasibility studies and we expect this process to be completed in the very near future. This will guide the vocational rehabilitation consultants as they choose providers for assessments and interventions and will ensure that our clients are receiving the highest quality of service available within an environment of outcome measurement and accountability. Under Section 16 of the Act the provision of vocational rehabilitation services is discretionary and workers’ entitlement to services is determined by the vocational rehabilitation consultant. The discretionary provision of vocational rehabilitation services is a norm across almost all jurisdictions in Canada. In Saskatchewan the Act sets out the obligation on the employee to accept vocational rehabilitation and to "take all reasonable action to mitigate the loss of earnings resultant from an injury." The question of whether or not vocational rehabilitation services should be a statutory right versus a discretionary decision is not ours to answer. What we can say however is that we attempt to offer services to all workers who are disadvantaged or handicapped as a result of their workplace injury. And for those who may approach us where we do not believe there is a mandate for our services we tend to direct them to other service providers such as the provincial government’s ERS program or other community agencies who may have the appropriate mandate. With respect to the issue of legislative re-employment there are currently five jurisdictions in Canada – Ontario, Quebec, Nova Scotia, New Brunswick, and Prince Edward Island who have legislated re-employment within their workers' compensation law. The rest of the jurisdictions do not. All jurisdictions do, of course, have a legislated duty for employers to accommodate workers with disabilities within Human Rights law. We have found that most workers and employers their rights and obligations with respect to the duty to accommodate. And one of the roles of the vocational rehabilitation consultant is to share information in a collaborative and educational manner with the parties involved in the return to work process. These issues are complicated ones and we will continue to provide training for our vocational rehabilitation consultants so that they are better equipped to answer the many questions their contacts have in these matters. The bottom line is, however, that our services are discretionary and there is no legal requirement other than through human rights legislation for an employer to re-employ injured workers instead we must turn to arguments of moral obligation and cost benefit in our effort to assist workers to return to work with their accident employers. As you know the Board is developing and piloting a new case management model of service delivery in order to improve effectiveness and outcomes and address some of the operational concerns raised by clients and other stakeholders with respect to the handling of their claims. The Vocational Rehabilitation Services Department has been involved in the development, prototyping, and piloting of case management and can say with great confidence that the move into this type of service delivery model is going to result in improved vocational rehabilitation services. The primary benefit is that case management model will promote earlier involvement and intervention by the vocational rehabilitation consultants. Where vocational rehabilitation consultants in the past tended to become involved in the claim at the time of physical plateau they will now be involved in the initial case discussions and return to work planning which occurs within a few weeks of the date of injury. The vocational rehabilitation consultants will provide expertise and support to the new case management team in developing and implementing return to work plans with the pre-injury employer.
Especially where alternate employment or worksite accommodations are being considered. Should the team fail to facilitate a return to work with the pre-injury employer the vocational rehabilitation consultant will, where appropriate continue to work with the client to establish and implement alternate vocational plans. The vocational rehabilitation consultant becomes a critical member of the case management team. They complement the other members of the team by providing expertise in: Vocational Assessment and Evaluation; Career counselling and planning; Disability adjustment counselling; Job task analysis; Work site accommodation; Employment Development; Job placement and; Disability Management.
The case management model will change the accountability for rehabilitation consultants from the historical linear management structure to accountability, first to the case management team. This will we believe result in more timely service, higher return to work rates, and a higher level of client satisfaction.
In closing off this part of today’s proceedings I would like to say that the Compensation Services Division and the Vocational Rehabilitation Services Department recognize the challenges that we face in consolidating the role and championing the mission of vocational rehabilitation services at the Board. We strongly believe that the vocational rehabilitation of our injured workers is a vital component of a successful Workers' Compensation system. Through our departmental business plans we will address the critical areas which have been identified through our own experience and analysis and through internal and external reviews and audits. We know that we can and must improve service levels and outcomes and in so doing raise the confidence level of our clients and key stakeholders.
QUESTIONS
JOHN STEEVES
Q: We might as well start off with Code R – and I – the change that you referred to and we talked about 2 weeks ago was one that took place in 1996 – I’m just looking for a sort of line to draw between the old way and the new way.
A: Yes, that’s correct.
Q: You are comfortable with roughly 1996 –so as I understand it before 1996 Code R was a payment to workers equivalent to wage loss and that was I think the term you used was for bridging to pension so at the day of plateau and there is some criteria in the manual and I think it requires things such as the – it looked like there was going to be extensive loss of earnings component to the pension and so on – the rehabilitation consultant had discretion to give the worker Code R benefits, correct?
A: That’s correct.
Q: And as I say that was equivalent to wage loss so there was no loss now the – what happened in 1996 was that there was a change to the rehabilitation procedures – thank you – manual and the change was and could you turn to tab 6 of the documents in the binder with the blue cover on it? And there’s a decision there made May 22 but if you could turn to the second page and you weren’t with us two weeks ago Ms Wakelin but this is a document that I got from Mr. Watson and it’s down at the bottom you see it says March 1996 – and this is the – that’s I think is Mr. Watson’s writing up at the top – forward and for proper formatting - and something and the next handbook revision and so and there’s a number of small changes here but the – if you could look under "Purpose" - the second paragraph it says "income continuity benefits may be paid to assist workers whose disability has plateaued and whose employability assessment has been completed." Now the change there was that prior to this change Code R could be paid before the employability assessment. Correct?
A: That’s correct.
Q; And just under "Eligibility" –there’s – or "Processes" there’s – it’s got – one, two, three, four - the fourth bullet there –it says "VRC – the vocational rehabilitation consultant will determine if there is likely to be a long term loss of earnings. No income continuity is payable until this determination is made and this will almost always require the completion of an employability assessment or some other situation." So that was the change that was proposed – that is a procedural change in 1996?
A: Correct.
Q: Now there was a big – we don’t need to get into the details of that – but there was a bit of a fuss over that.
A: Well I believe the fuss as you refer to it also was with respect to a change around the rate level that would be paid.
Q: I think that’s right – there were two parts of the conflicts at the time – one is that Code R wasn’t going to be paid until the employability assessment was done and the second complaint was that even those people who were on – employed – on Code R would have the rate change to the job that was considered suitable as a result of the employability assessment.
A: In those cases where 100% loss of earnings was not being recommended.
Q: Yes, yes, yes, so now – the – I’d like to take us up to date and we tried this last – two weeks ago and there wasn’t time to develop it further but there’s some concern about what actual recommendation was made by the Bureau to the Panel of Administrators about – about the change and I think the concern of the Panel of Administrators is that even if there was a change of procedure and it is controversial it should come to them and we don’t need to get into that – I just want to get into the details of what the change was – as I understand it the change that the Bureau has recommended to the Panel of Administrators is that you can have code R before the employability assessment is done but and you can change the rate on Code R but you have to give 30 days’ notice to the worker – have I got that right?
A: Not quite; there’s actually three components to the changes that have been requested through the Panel of Administrators - two are what I would categorize as sort of smaller changes – one is with respect to the language around the workers having to be unemployed to receive income continuity benefits – we are asking to change that to recognize workers who may have returned to work paying less than their original wage loss rate so we are asking for a change to the language there. We are also&ldots;.
Q: So that would make Code R a kind of top up provision?
A: Yes.
Q: All right.
A: The second change is with respect to individuals who may come back for a pension reassessment and currently the language of the policy states that where there is a pension on the claim income continuity benefits cannot be paid. So we are asking for a change there.
Q: That is a longstanding problem isn’t it?
A: Yes it is.
Q: Yes.
A: And the third change is with respect to the change of rate for income continuity benefits once the employability assessment is completed and requests that a wait period be put in place before that reduction or change in rate would come into effect.
Q: Okay; and but the – statements in this if I could call it this draft change – March 1996 – that the – there could be no Code R until the employability assessment had been done – that’s not part of the recommendation to the Bureau?
A: No.
Q: Okay; now the – in 1996 – before 1996 and now – there’s a significant backlog in disability awards is there not?
A: I really couldn’t speak to the backlog in disability awards but &ldots;.
Q; There are delays - you can speak to that?
A: There are usually delays in disability awards with respect to pension assessments, yes.
Q: Yes. And Mr. Buchhorn were you going to&ldots;?
A: I think you’ll see the numbers tomorrow but the backlog has been reduced from about 2500 claims to about 1200 claims I believe is what you’ll be seeing tomorrow.
Q: Okay, I was more interested in the time and the
A: The timeliness has been reduced but we are still looking at between 8 months and a year for the establishment of a loss of earnings pension. On average.
Q: Right and yes and certainly in 1996 when this change came in it was somewhere around a year.
A: 14 months I believe.
Q; Yes, yes. And I guess what workers see is they see the change to Code R related to the delays in disability awards – and I’ve explained that to you a bit – that is if a pension decision could be made within say 2 or 3 months of the date of plateau we wouldn’t be even getting into this so called problem with Code R. That is your expenditures on Code R would be down compared to what they are. Another way of putting that is the reason for Code R expenditures were so extensive was because of the delay in disability awards because people were on Code R waiting in line in the queue in disability awards. Would either of you like to comment on that?
A: Yes, I’ll comment on that. The delay, as you refer to it, with disability awards I wouldn’t want anybody to think that it’s only an administrative delay in that department. Part of the whole process of conducting an employability assessment which is an integral part of a loss of earnings assessment is the completion of that employability assessment – for some the delays could have come as a result of vocational rehabilitation delays, some of the delays could as well come because of other medical information that needed to be gathered as part of the process.
Q: Yes, you’re right - I did make that too simple –it’s a complicated explanation of why there’s a delay - my point though is that if there was no delay there would no issue on the Code R – expenditures on Code R would be down and I am suggesting to you that we wouldn’t have this need fo the change in 1996 and we wouldn’t have had this conflict that we are still kind of working our ways through. Is that a fair comment?
A: Certainly.
Q: All right – now I’m interested in what you referred to as Code U – and I think you referred to that as a relatively new?
A: Yes it is a relatively new code.
Q: How new ?
A: I believe it was introduced either in late 1995 or 1996.
Q: So roughly the same time as these changes to Code R had taken place?
A: Right.
Q: And isn’t the difference between Code R and Code U that Code R is within the authority of the VRC –the vocational rehabilitation consultant - and Code U requires a budget to be approved by a manager?
A: They are both within the authority of the vocational rehabilitation consultant up to certain financial limits in the case of Code U at which point it has to go to a manager for approval. You are correct in that the Code U shows up on a actual budget and Code R does not show up on a budget.
Q: Yes, and the - just to add a bit more detail to that - the consultant on a Code R can say this man – pursuant to the policy assuming that the worker complies with the policy - is entitled to Code R and that kicks in Code R and they get equivalent to wage loss and that continues until their – currently –it continues until they get their pension whereas with Code U they have to make an appl – put a budget together and present it to their manager to be approved?
A: That’s correct.
Q: And can we take it that that would mean that certainly there would be more control by management over the expenditure of funds for Code U than there would be for Code R?
A: Well, Code R used to be – I’d have to check with Mr. Hartmann on this – a time based code that still required a manager’s approval at certain points in the process. Chris could you confirm the timeframes for me? There was with Code R the rehabilitation consultant could approve up to the initial 12 weeks and any extension beyond the 12 weeks must go to a manager for approval. So there’s no change to that – it’s been like that for quite some time. I might add Mr. Steeves that these changes were made in keeping with the recommendations by Hunt and Lahey in their 1995 evaluation in that there was a sense that there needed to be more accountability, more outcome measurement in terms of the various vocational rehabilitation expenditures and interventions. So the former director of rehabilitation, Dr. Harder, put in place these particular codes that more accurately reflected the expenditures and outcomes of the vocational rehabilitation department. So that departed from as Ms Wakelin said the practice of using Code R to park everyone while they were waiting for a vocational rehabilitation intervention.
Q: Right – what is this term "park"?
A: Well, it’s if you have a high case load and you perhaps are looking for ways to deal with your clients on that caseload you want to maintain income continuity for those clients so you might what we call "park" someone on income continuity. I think we’ll hear from Mr. Winter later some concerns about the outcomes of those particular cases relative to I think some very embarrassing situations.
Q: All right - I was looking at your slide – the - Ms Wakelin or – actually Mr. Hartmann – the one that has the medical recovery then you go to the – the busy ones –
A: That is Julie’s.
Q: Ms Wakelin – Do you have that Ms Wakelin?
A: I’m just going to get a larger copy of that one.
Q: Okay - now this is what is going on now is it?
A: These are two out of what could be numerous situations.
Q: Yes but – two of numerous situations – I notice though that just taking the one up at the top that the – you have code U at the beginning and - but code R doesn’t start until after the employability assessment is complete?
A: Correct.
Q: Why wouldn’t you have Code R from the beginning? Given that the – that’s what the – the policies and procedures says?
A: In this case this is meant to reflect the example that I gave you earlier in my presentation. A worker who initially indicated his desire to work with a vocational rehabilitation consultant was started a job search – for – while they were planning on the outcome Code U would be the appropriate code – as is it is with probably the majority of our clients they have completed Section 29 or Section 30 benefits.
Q: Are your consultants paying Code R now prior to an employability assessments?
A: They are not supposed to be.
Q: I am sorry; I thought that they were permitted to that under the current policy and practice? And procedure?
A: Sorry – pay Code R prior to an employability assessment completed? No. The current practice asks them to complete the employability assessment prior to initiating Code R benefits.
Q: Is that in writing some place?
A: Yes, it is.
Q: And where would that be?
A: It’s in the section that you referred to although I’m looking at this I’m not sure you have the most current but it is Rehabilitation Procedure Handbook 090010.
Q: Ms Wakelin, in preparation for this hearing about 3 weeks ago I ordered a copy of the Rehabilitation Procedures Manual and that is the section of the manual – it is dated at the bottom – is it April 1995?
A: Yes, that’s correct.
Q: And that’s 090010?
A: Yes that’s correct.
Q: And can you – the panel doesn’t have it at this time but – is there anything there that says the Code R will not be paid until after the employability assessment?
A: It is implicit in one section where it says use – actually – quite frankly I don’t think this is the most current one because – it may be – we haven’t incorporated Code U into this section yet, that will be coming – it is implicit when we say to use Code e versus R for vocational rehabilitation planning purposes.
Q: So other than an implicit statement in that document there’s nothing there that says Code R will be paid only after the employability assessment?
A: I can’t see it in this one, no. I just wanted to make one point – with reference to the statement that the policy of the Board has always been to pay Code R and this has given rise to some of the issues that arose since 1996 – has never explicitly stated that -
Q: All right; stated what?
A: The statement that Code R will be used – there’s no reference – you made a statement John – Mr. Steeves – that Code R is in policy. There is no reference to Code R in the policy. It’s always been a procedure that the department it goes to – it’s the department’s interpretation of words like "will generally be paid the rate of compensation or the department’s interpretation of things like "in payments and the amount at which they will be paid may be continued at the discretion of the vocational rehabilitation consultant." But I just wanted to be clear that that the explicit references to Code R or any other code for that matter and the amounts have never actually been in the policy and that is what I think created the furor is that the department changed its long standing practice.
Q: I was going to deal with this in April but Mr. Pinto the problem is that we had the April 1995 procedure in place in which consultants were paying Code R before the employability assessments and now we are told that they are not paying Code R until after the employability assessments and the procedure hasn’t been changed.
A: That’s a separate issue. I believe the procedure has been changed what Ms Wakelin is indicating is that the copy you got for whatever reason does not have the updated procedure – my point was related to the change – I just wanted to correct something that – I think you said a couple of times – that the department had changed the policy – I think we all agree in retrospect that the de facto effect of workers’ benefits and clearly it’s been made clear to the division that that should have gone – that those kinds of changes should go to the Panel of Administrators in the future.
Q: Yes.
A: The policy was not explicit.
Q: Ms Wakelin could you canvas a few of your consultants and have them look in their procedure manuals and see whether they have that April 1995 procedure or a later one?
A: Yes I certainly will.
Q: And if they have a later one could you – or someone at the Board explain to me why when I order a procedural manual three weeks ago I get – I don’t get a current one?
A; And I do apologize for that – that’s certainly not appropriate.
Q: A couple of things on Code R –the graph you had – Code R expenditures – it’s a couple before - two before the one we just looked at – and it is a pretty dramatic graph – it shows a series of expenditures up to 1995 and then a very significant drop in 1996 and 1997 and you – when you were talking earlier – you talked about Code R expenditures under control - are you satisfied with that dramatic reduction in Code R expenditures or would you –it strikes me as a rapid decline – indeed a dropping off on – is it net figures or yes?
A: Yes.
Q: A minus figure on net – and so in the process of two years we go from 7.5 down to minus 1.7 net and that just looking at the graphs strikes me as a dramatic and are you not concerned as a manager at that significant drop?
A: I don’t know if concerned would be how I would categorize it; I think you really have to refer back to what was happening in 1992, 1993 and 1994 with respect to the misuse of income continuity benefits and then with the dissolution of the department in 1993 there really wasn’t any good management control in place as we spoke about a little earlier. It’s very hard to quantify what should be an appropriate level of expenditure in any vocational rehabilitation code. If you asked me to target how much should we be spending in job search allowance or how much should we be spending in planning I couldn’t give you an answer because so much is dependent upon the client base at that time and the number of referrals and many other factors. I would agree with you that this appears to be an alarming drop and I know that it has caused a lot of concern within the community. I do believe however that with the change in practice and the change in focus with the clinical oversight that certainly in place that we are intervening much much earlier with workers, we’re providing the kinds of interventions that will keep them focused on goals and some of the Code R drop was picked up in other codes. Now it doesn’t match – it doesn’t’ come up to the level of earlier nor would I have expected it to considering the drop of referrals. But we are watching it and monitoring it very very closely. I would like to add Mr. Steeves that there’s also an alarming rise – to use your terminology – that precedes the alarming drop and to characterize the 1995 expenditures in the Hunt and Lahey Report they were out of control. And there was a very strong recommendation that we take control by clinical supervision, by ensuring that we were achieving better return to work outcomes. Does anybody care about the outcomes of the expenditures or are we just in the game of spending money? Because that was the point that was made – you are spending $70 million a year and you are getting less return to work outcomes than you were in 1993. That was the point that Hunt and Lahey made.
Q: We’ll come to that in a minute Mr. Buchhorn but I guess from a management point of view I’m interested to know whether the 1997 figures –gross and net – 3.2 and minus 1.7 respectively - is that where you want them to be over the long term or do you have an idea of that?
A: Well, again, it’s very difficult to quantify where we should be because I can’t predict how many very seriously injured workers could be referred next year and it may result in a significant increase again in income continuity for those individuals who meet the criteria.
Q: Well surely you have some idea –you do some planning based on the number of workers over the next year or next two years, don’t you?
A: We make some projections, yes.
Q: And are you projecting your preferred costs on Code R over the next couple of years?
A: No, we haven’t projected preferred costs on Code R in any detail. What I would also want to point out to you though is that it’s always preferable to have vocational rehabilitation intervention and planning happening and plans in place for workers. So as I pointed out earlier in my presentation many workers who in past practice would have landed on this Code R benefits are now be in receipt of other benefits while they are fully engaged in vocational rehabilitation planning. Mr. Steeves what I’ve said to our vocational rehabilitation consultants and what I’ve said to our outside community on numerous occasions is that the aggregate numbers should be less of a target than doing quality vocational rehabilitation for each individual who is referred to the department and when you add up all 3000 or 5000 interventions that’s the right amount of money if we are doing a quality job. We don’t have targets with respect to the money we expect to expend – we have individual plans with each individual worker who is referred. When you add them all up that’s the right amount of money to spend on this particular intervention.
Q: One last question on Code R that sort of spins off from it –Ms Wakelin you’re talking about – again going back to that complicated slide – we don’t need to do it but – about a person deciding to retire in which case they wouldn’t be entitled to a loss of earnings pension and so on only the functional – correct?
A: Yes, based on the vocational rehabilitation consultant’s assessment. That individual couldn’t return to work that would match their pre-injury earnings.
Q: Yes and I - what we hear from workers is that – retirement is not always a happy occasion for them –it’s not what they thought they were going to have to do at that particular age and at that particular income level and that reason they retire is because they can’t do their job anymore and there’s no alternate work because they are old, because of education, skill levels and things like that –my point is that retirement is sometimes a controversial issue in itself in determining employability assessments.
A: Yes I would agree with you.
Q: And the term in the manual is retirement is a matter of personal choice, correct?
A: Correct.
Q: And personal choice is not defined there –there is much detail in it but there are probably two situations that we hear of - one is where someone generally - as a matter of personal choice - decides to retire –which is to say if they didn’t have the work disability they would retire anyways and then the second possibility – the second possible definition is that because of a disability they are obliged to retire because they can’t work anymore and they can’t get other work – can you say if personal choice as it is used in the manual refers to both of those definitions or to one?
A: It’s a very broad concept and I would say that it referred to both.
Q: All right - and in a situation where it is a personal choice in a sense that they don’t have any – it is kind of a misnomer – they don’t have any choice –that is they would retire except for the disability is that considered as part of the – as a loss of earnings factor?
A: Is personal choice considered &ldots;..
Q: Personal choice in the sense that they wouldn’t have retired except for the work injury or disease?
A: Well, that’s a very broad sort of question – I’ll try to answer it the best I can – when the vocational rehabilitation consultant is doing or completing an employability assessment many many factors have to be taken into consideration – and talking about retirement or withdrawing from the workforce – results in generally a lot of discussion between the vocational rehabilitation consultant and the worker – where you talk about a worker through personal choice related to the disability exercising a retirement option I would – gleaning from your comments that you may be talking about somebody who after some attempt at looking for sort of alternate employment has not been able to find it – and if in fact the rehabilitation consultant is in agreement that it is unlikely that this individual given their residual profile is going to find suitable and available employment then that would result in a loss of earnings recommendation that may be what we would call a 100% loss of earnings. It is very difficult to answer each specific circumstance.
Q: No, thank you.
[Terry Robertson interjects for a break]
Q: Ms Wakelin, during the break you have given me a copy of the document –I think you had a third version of 090010 dated September 1996?
A; Yes.
Q: Where did you get this?
A: One of my staff brought it for me and you also asked if we could canvas the vocational rehabilitation consultants?
Q: Yes.
A: We’ve done a little bit of canvassing and it would appear that those people that we spoke to have got the latest version, September 1996 version.
Q: Okay –Now I explained the problem I had in ordering the manual from publications and it didn’t have this in it – apart from my situation there’s a more serious consequence of that I think that if this were not a Royal Commission and I went to the Review Board appealing a decision and I took the manual that I obtained from Publications as I said – this is what the manual says – this is what they did if not in the manual I would probably win the appeal.
A: I recognize your discomfort with&ldots;.
Q: It is not my discomfort – it is a system problem I am talking about – I’m not here for my personal comfort. I’m here to try and make the system better.
A: I do apologize for that. We will ensure that we will follow up with films and posters right away to make sure that doesn’t happen again and that everybody who needs to can get a copy of the most updated manual.
Q: Now we’ve already gone through the recommendations from the Bureau to the Panel of Administrators right
A: Yes.
Q: And it is different than the September 1996 of this Code R procedure, correct?
A: Well, different in that it says requests for a change in the policy rather than in the procedure. It’s through policy changes.
Q: Yes and the recommendation from the Bureau is that it it –this is the point Mr. Pinto was making - is the recommendation that is a change in policy that Code R be paid after – or that Code R be paid before or after the employability assessment?
A: That is not part of the policy change that we are seeking. That is an administrative method of administering Code R benefits and as I indicated earlier normally what would happen is the individual would receive another form of wage replacement; either Code U or Code e rather than Code R which would be payable only upon completion of the employability assessment.
Q: I’m sorry the recommendation from the Bureau to the Panel is that Code R can be paid before the employability assessment &ldots;..
A: To the best of my knowledge I do not believe that that is – forms part of the recommendation.
Q: I’m sorry –I thought that is what we talked about the first thing in the morning – there are three things that’s gone to the Bureau and the third thing was that Code R can be paid before the employability assessment.
A: No, the Code R – it is a change in benefit level that is the third component of the policy changes.
Q: Yes.
A: The first two I referred to was with respect to unemployed as an issues; the second is with respect to a reassessment for pension
Q: Yes.
A: And the fact that currently where pensions are in place it is not &ldots;
Q: It can’t be Code R – yes
A: Right. And the third is with respect to payment of the adjustment of a rate in the income continuity level following completion – I would assume the employability assessment – but after the 30 days has elapsed. Under a policy in our policy manual a client is entitled to receive a copy of the employability assessment once it has been completed by a vocational rehabilitation consultant.
Q: Yes.
A: And that is a 30 day window during which the client has the opportunity if they so desire to provide input to the claims adjudicator in disability awards prior to the final pension decision being made.
Q: That’s always been true – that has nothing to do with Code R.
A: Well, you know that has not always been true; it is a relatively new section of the policy manual has been added fairly recently – I don’t know the exact date.
Q: No but – whether the worker has an opportunity to spend 30 days to comment on the employability assessment is a separate issue about whether Code R can be paid prior to the employability assessment&ldots;
A: Yes, that’s correct but what we were trying to do and what we are trying to do with the policy changes is to bring practice with respect to the timing in line with the policy change we are recommending.
Q: And the practice with respect to payment of Code R?
A: Practice with respect to the time frame during which the benefit level might be adjusted.
Q: And the recommendation from the Bureau to the Panel of Administrators is what on that issue?
A: That it be 30 days.
Q: 30 days
A: From completion of the employability assessment.
Q: Right. And implicit in that is not that Code R can be paid prior to the employability assessment?
A: No. Perhaps Joe would like to make a comment. I perhaps want to – what the policy currently says is that the payment is generally based initially on the same rate as wage loss benefits and is expected – and it is paid on the expectation that the worker as far as is capable actively participates –so the important part was the first part of that sentence.
Q: Is this 89.11?
A: Yes.
Q: Yes.
A: Initially it is paid on the same rate as wage loss benefits now as I was explaining earlier the codes are a matter of practice. What – the policy then goes on to say payments and the amounts in which they are paid may be continued at the discretion of the vocational rehabilitation consultant. What this policy change recommendation in effect does is starts with the notion that payments will initially be on a wage loss equivalent. It retains that that aspect of the policy. What the practice change the department introduced was that at some point in the process the benefit will reflect the outcome of the employability assessment. Okay? So what the policy recommendation is that – that – that practice be adopted – that it not – that – that reflection on the employability assessment not occur for 30 days until the worker has had an opportunity under a separate policy as you point out to comment and offer any criticism because it is implicit in that if the worker makes a valid point about – I don’t agree with this -
Q: Right, we’re not talking about that.
A: Yes. But what I – what the Bureau appears to have recommended and it is necessary to speak to that benefits will remain initially at the wage loss equivalent with the department but by practice we’ll be doing by continuing it – that wage loss equivalent under one of the alternate codes that Julie referred to. Once the employability assessment is done and 30 days have elapsed and the department has not changed its opinion then the estimated rate or the rate that emanates from the employability assessment will be the rate on which is paid. So there will be no references as far as I understand the Bureau is recommendation to Codes even in the new proposed policy – I don’t think they proposed getting into the Code R issue. That is what I was pointing out earlier that this policy doesn’t make reference to Codes.
Q: Mr. Chairman I don’t want to take any more time on this and there’s appropriate privacy issues as to what the Policy Bureau recommends to the Panel of Administrators and I was hoping to avoid getting into that –I don’t think I can any more and so I’m going to ask – I guess I’m formally asking Mr. Bates, who is counsel for the Board, that if we could have a copy of what the Bureau said to the Panel and if there’s problems with that we can check that out later but if I could just put that on the record.
[Judge Gill]: All right, is there any problem with that Mr. Bates? Could we have a copy of any written record of the actual recommendation by the Bureau to the Panel of Administrators with respect to this issue?
A: While Mr. Bates is thinking of his response I might point out that and the Bureau is here to speak for themselves on the issue but I think that their general position is that the recommendations that they make to the Panel are the recommendations they make and they are not circulated. They circulate the proposed issues to the stakeholder groups but the recommendations to the Panel of Administrators are as a matter of course not circulated and are not privileged recommendations. They may feel in this case because the discussion as arisen in this forum that it’s appropriate but I’ll leave that to respond.
Q: My point Mr. Chair is that we have spent I think too much time on this already and we just need to get to the heart of it and if one document might help us do it I suggest that we try to facilitate that – the document isn’t privileged by the way but as I indicate I respect the privacy issue between the Bureau and the Panel of Administrators but I think one document can help sort this out and I suggest that we talk to Mr. Bates later about it.
[Judge Gill]: Well what about Mr. Bates; do you have any instructions Mr. Bates?
[Mr. Bates]: Not now Judge Gill but perhaps I would anticipate I’ll be able to advise you after the noon break after discussion with Mr. Steeves and with the Policy Bureau and with the Chair.
[Judge Gill]: Very well, the request is on the record and we will deal with your request Mr. Steeves.
Q: Thank you Mr. Chairman. Mr. Buchhorn you invited us to get into the number of referrals and what is really going on here so I suggest we turn to that – now – we turn to the slide - vocational rehabilitation; new referrals – I guess it is closer to the top than the bottom – now as the slide indicates from 1993 to 1997 – slight rise in 1994 then a drop off to 1997– and I’d like to explore some reasons for that drop off and Ms Wakelin you indicated 3 in your comments –one was that there was less claims; the second was earlier treatments; and third was – you referred to it as a formalized referral system –is that what is called an "rpm"? is that what you mean by that? Rehabilitation Performance Management?
A: No, the formalized referral system that I was referring to is simply a referral form that the claim adjudicator must now fill in prior to sending a file over to vocational rehabilitation services for an assessment with respect to service level and eligibility.
Q: Okay and that would reduce the numbers by adding some administrative controls over to referrals?
A: Correct.
Q: So - it is not a reduction in the actual number of referrals it is a reduction in the kind of referrals that are made?
A: Well I would think it would probably be both – we do have articulated referral guidelines as well that we would the claims adjudicators to follow but sometimes in the past they weren’t following those guidelines.
Q: Yes yes – and I want to explore that a bit - the articulated guidelines – what is the date of those?
A: They been there as long as I’ve been at the Board since September.
Q: Okay and one of the other changes that has taken place since roughly the mid 1990’s is what we know as the five phases of rehabilitation in the manual?
A: Yes.
Q: And one of the changes that took place in 1994/95 is that phase one and phase two of that process was taken away from rehabilitation and given to the adjudicators?
A: Yes, that’s correct.
Q: So those numbers would be taken out of the total?
A: Right. That is a good assumption to make, yes.
Q: And do we have any sense of what those numbers are?
A: No, I’m sorry we haven’t tracked them.
Q: Okay – and then another change that took place in 1994/95 was 80.30 of the manual which was preventative rehabilitation – correct?
A: Yes.
Q: And prior to that there were a number of referrals to rehabilitation which were considered to be inappropriate and 80.30 was a response to that and as a result of that there’s been fewer referrals than there were before?
A: I’m not sure if 80.30 was a response to the nature of the referrals – preventative rehabilitation has been one of the services that we provide for a considerable length of time.
Q: Yes, but it’s defined specifically in 80.30 isn’t it?
A: Yes.
Q: And it was not specifically defined prior to that?
A: I’m sorry I don’t know.
Q: Okay – and the - there is a further change with respect to suggested pain referrals – those no longer go to vocational rehabilitation?
A: That’s correct.
Q: Okay –
A: Mr. Buchhorn would like to make a comment. I think what we’ve said is there are fewer of them not that they are not referred but that the earlier intervention through the clinical intervention phase has resulted in fewer of them not that they are still not appropriate to go there if at the end of the clinical rehabilitation there is still no return to work.
Q: Yes, but my point is if it wasn’t for those changes we just talked about it that the number of 67.31 and 97 would be higher?
A: I suspect it would be, yes.
Q: Now could we jump two pages to the slide "The RETURN TO WORK as a percentage of New Referrals" – and perhaps you keep your finger on the one we just left – now and it shows a dip in 1994 and an increase in – up to 1997 and the 36% in 1997 as a percentage of the 67.31 in 1997 is it not?
A: No, what the second slide shows is – sorry yes it is – it is new referrals.
Q: So – the 33% in 1996 is –is 33% of 67.32 in 1996 and so on?
A: Could you just give me a moment – I’d like to speak to Mr. Hartmann about this. Yes, that ‘s correct.
Q: Yes. So – the – going back to 1997 – it’s 30% - 36% of a smaller number than the previous years, correct?
A: Yes, that’s correct.
Q: So that would be an explanation for why there’s an increase in the percentage in return to work as a percentage of new referrals?
A: Yes.
Q: Moving on to another area –I just want to speak briefly to you about relocation in the context of loss of earnings -and I’m looking at section 40.11 of the manual –and it says reasonable – this is number 6 of the sort of criteria which is a reasonable job - reasonably available job is one that is in a reasonable commuting distance of the worker's home – do you recall roughly where that is?
A: Yes.
Q: And where there is no available job within that commuting distance – the worker could be reasonably be expected to undertake – the worker might be expected to relocate depending on age, the availability of a suitable job elsewhere and other factors –but relocation will not normally be expected unless the worker is offered the expenses of relocation either by Unemployment Insurance Commission, CO, by the Board or something else, do you recall that?
A: That’s correct.
Q: And from time to time we’ve had concerns about – workers have had concerns about the pressure on workers to relocate in order to obtain other work as part of the loss of earnings – employability assessments basically–and I just want to – every case is different and I just want to give you two extremes to kind of set the boundaries here –and one extreme would be a young single worker who has moved around in his short career and who as a result of his injury who can’t work in that career anymore and has to change and it would be reasonable to ask that person to maybe relocate to a different place all things being equal – that is one extreme –now the other extreme would be an older person married, the spouse has a job in the town, his kids in school and there’s other family and can we take it that is another extreme where it would be unreasonable for the Board to expect that person to move?
A: I certainly recognize that there are extremes with this very difficult issue and the examples that you have given would probably be accurately portray this – the spectrum.
Q: Thank you – and in truth most of the other ones are somewhere in the middle.
A: Yes.
Q: Mr. Hartmann talked about the statutory right of rehabilitation – I want to spend a few minutes on Mr. Hartmann if I could - and you reviewed the situation and as you put it you - the Board down to the lowest level has a moral obligation only in terms of rehabilitation and the Board’s briefing paper on this issue – page 13 talks about this issue and they describe a trend towards a statutory right or actually to be more precise statutory requirement that employers accommodate the employment of injured workers – are you familiar with that &ldots;.
A: Yes, right&ldots;familiar with the trend.
Q; All right and that coincides with the graph you had in your slides – and what that does is what the paper goes on to talk about is it codifies – codify – that’s my word – about the duty to accommodate that should exist there in any case –is that your understanding? So for example in Ontario where a worker has worked at least one year and an employer has at least 20 workers, the Board will notify the employer about the level of the fitness of the worker and the worker –and then there is a requirement to accommodate that worker – that is an example of how that would work?
A: Yes, that is our understanding.
Q: And one of the problems with a discretionary system is that as a result of experience rating assessment the claim goes beyond two years then there is no economic incentive on an employer to get someone back to work is there?
A: Yes, that’s correct.
Q: And you - that is an issue in your department?
A: Yes, when we face in varying degrees depending on the knowledge of the employer.
Q: Yes yes.
A: And it can be up to 30 months. Not just the two years. Depends on the exact date of injury when that happened in the year.
Q: A couple of other areas – one was case management – now I wasn’t sure –I’m still not sure where the vocational rehabilitation consultants fit into case management –as I understand currently at least not many of them are attached to the case management model – have I got that right?
A: Right, the – to this point the pilot for case management has just started up in North Vancouver office – or will be starting I guess next week on Monday. Prince George has been developing the prototype for case management and they have also now moved to a pilot phase. So those are the only – really Prince George is the only office that has had experience with working in that model and in a developmental way not in a final version.
Q: All right and in Prince George for example are the vocational rehabilitation consultants part of the case management team?
A: Yes they are.
Q: So there would be the case manager, a – just run us by the team.
A: It’s a case manager – actually it’s a – I think the model up there that they were using there were 3 case managers on a team, two vocational rehabilitation consultants, a physician, one of the Board’s medical advisors, and an occupational health nurse, and there will be a team assistant or several team assistants involved as well. A psychologist will be there as well.
Q: And is the concept to have ultimately all vocational rehabilitation consultant as part of the case management team? Case management concept?
A: Certainly the ones working in the Service Delivery Locations – there would be some exceptions for vocational rehabilitation consultants that work in specialized locations such as the rehabilitation centre. Which their teams would vary depend on the needs of the individual program.
Q: And will the consultants’ duties stay the same within the case management model?
A: Certainly the duties – I guess the tasks – the day to day tasks would stay the same in relation to the last three phases of vocational rehabilitation but they will also be providing expertise and advice – input into the planning – the return to work planning that’s held quite a bit earlier on at the four week or 6 week point following the date of injury.
Q: Okay and some of your consultant have expertise in certain areas –I understand – I’ve seen expertise in western red cedar dust asthma for example – getting people back to work on that and are those developed expertise – is that going to be protected or enhanced or what is happening with that?
A: Well I think right now those rehabilitation consultants that have those expertise are working in individual Service Delivery Locations and so that will continue.
Q: Okay – but does it mean that and I don’t know how many of your consultants would have that expertise – let’s say 3 – and if those are attached to specific case management teams does that mean their expertise will not be available to –other case management teams that have western red cedar dust asthma cases?
A: Not readily available, however, they are recognized as having a specific expertise that they would still be – the other teams would still have the ability to be in touch with them – contact them for information – for advice. Perhaps I can respond to that as well. As you are no doubt aware the vocational rehabilitation consultants had been part of the occupational diseases section were moved out I believe it was last year into the Service Delivery Locations in recognition of some of that very specific expertise. We are in the process of providing training all across the province. Last fall we provided training on the asthmas – the things we talked about yesterday. Dr. Ma and Dr. Whitehead came in and did a presentation for all of the consultants in November. We intend on carrying on the training because we do recognize that it’s an area of considerable concern and we want to make sure the consultants are well trained right across the province on all of those issues.
Q: Yes I and our concern in response to that –is that is no longer developing expertise that’s taking on a general level – I’m a lawyer I know something about criminal law but you wouldn’t want to hire me as your criminal lawyer and I wouldn’t take the case so – I – I - it strikes as kind of diluting the of the expertise developed at the Board.
A: That would be one perspective and I don’t happen to share that perspective. The vocational rehabilitation consultant’s job is a very broad and complex one. Part of their area of expertise has to be – or has to do with medical aspects of disabling conditions. And we are just not talking the medical aspects of an orthopedic injury or the medical aspects associated of some other injury. They must develop and have that expertise in all disabling conditions. So it is an expectation that they do have a level of training that will allow them to perform their job function properly.
Q: All right – so it is a moving – it’s making consultants into more generalists than they have in the past.
A: Well, the vocational rehabilitation consultants have always been a very generalist job; it is within the profession, within the practice.
Q: But currently there are certain consultants who are known in the system who have expertise in red cedar dust asthma and they would get those claims now whereas under the case management model they wouldn’t be involved in the case unless they were in – worked in that particular case management team or unless someone had the sense to phone them up.
A: Well, in actual fact we are in that decentralized model already. We no longer have vocational consultants assigned to the occupational diseases area dealing with specifically or solely with issues like red cedar.
Q: I’m going to talk about employability assessments if I could for a while –and the term in the manual that – it’s the term we use is a job has to be reasonably suitable and available correct? That is the language we use when we talk about this and I was concerned about –last night I read in the Hunt Report –he was concerned about the – this is the 1995 report –the reduced time the consultants spend in the community and indeed I think you indicated that that 4% satisfaction was one of the factors in there?
A: 4.5 and yes it was.
Q: 4.5 and indeed what we’ve seen – used to see vocational rehabilitation consultants- their first contact with the worker was to go to the worker’s home – and we don’t see that very often so it is just anecdotal – you know I see it from my point of view too – it’s always struck me –it was surprising to the worker – the worker would phone up and say why are they coming to my home? And we had to deal with that. But it always struck me as a good thing to do –it’s not happening as often any more – that seems true objectively – is there any concern about that to try and address that?
A: Well, yes there is. It’s not so much visiting workers in the home because we trying to discourage that for safety reasons wherever possible now. We have to be aware of our vocational rehabilitation consultants’ personal safety. So we generally say our first contact with the worker should ideally take place in the workplace with the injury employer and the union representative and whoever else that needs to be a part of the process there. There certainly are still cases especially in serious injury where a home visit would be most appropriate and necessary in cases where we are providing some home care or in-home assistance so it is a bit of a balancing act. My preference used to be always see workers in their homes until I was dissuaded of that. And now because of the safety issue we do ask our consultants to be very careful when they choose to make home visits.
Q: The safety issue is perhaps we could put it this way angry workers – is that what you are talking about?
A: Well, personal safety in general. It’s an issue that has been driven by compliance with our own regulations where in discussions with our own union we have tried to comply with our health and safety around personal safety. People working alone and as a result unfortunately from my perspective we aren’t doing that as often and it is a frustration I think to certainly the people at this people that we are not providing more individualized service. There is a major push to get all of the decision makers into the workplace and certainly where there are significant disabilities we continue to want people to visit workers in hospital, visit workers at home or visit workers wherever it is appropriate.
Q: I just want to talk a bit more about this safety issue – what percentage of visits – potential visits by consultants that involve a safety issue?
A: I would say from my personal experience very very few but we can’t take the risk – it’s just not appropriate to put our people in a situation where their personal safety might be endangered. And it is not just by an angry client – we deal with a broad population and I think we all have to be aware that there are people in the community who may not have the same regard for personal safety that we would – we would hope that they would. So I certainly wouldn’t categorize the majority of workers as being a danger or a threat – far from it. But we need to be aware of the possibility.
Q: But I was told some time ago that safety was always an issue even when consultants used to go out routinely and that if safety was an issue they wouldn’t go out –so I don’t hear you saying anything different than what was the practice in the past and but what I do hear you saying is that because of problems with a very few workers a good service introduction – or a good introduction to the service of rehabilitation is not being done any more?
A: Well I would suggest that that good service could be provided just as acceptably at the work site as it could at somebody’s home. It may not feel quite as personal but I believe the consultants possess the skills, the communication skills and the interpersonal skills to make it feel like a personal intervention at the work site. And it is not just as Ms Wakelin said the issue of the client. It’s the issue of people working alone without any ability to protect them from a whole variety of things which happened to people regularly – sexual assault, those kinds of things.
Q: Yes, we have already established that it is a very small number Mr. Buchhorn.
A: Yes, however, in compliance with their own regulations we were required to do a risk assessment, work with their own trade union in determining guidelines that are deemed to be appropriate to protect the health and safety of our own people and while that has had an impact as we said on home visitations we are trying to make alternate arrangements to ensure that people will still get the same level of service, the same personalized contact but wherever possible we prefer that to be in the workplace.
Q: And just comparing the workplace with the home – when a consultant -a professional consultant visits the home the advantage of a visit in the home is you get an understanding of the family dynamics –you sit around, you have a up of tea, the kids are around and you see how people live –that’s that can be significant in getting people back to work – correct?
A: Yes, absolutely.
Q: Let me take us into another area that’s deeming –and first of all can we assist the Royal Commission and maybe ourselves in understanding what deeming is –and just to give you my view –deeming is a decision by the Board in legal terms that a worker is capable of working at working in a certain position in the context of the worker refusing to work cooperate in the – that decision – it’s not using much language from the policy manual but that’s my understanding of it.
A: I first of all let me say that the issue of employability assessments, pensions, and deeming is going to come up tomorrow during pensions so I’m not sure if you want to spend some time today – that’s quite fine with us if you would like to.
Q: I’m please to deal with it tomorrow; I’m just not wanting them tomorrow to say that I should have raised it today.
A: No, and I’ll be at the table tomorrow as well.
Q: Okay, okay, good. Just let me take you –it’s that binder of documents that should be there unless someone scooped it again – it’s tab 27 – you may want to defer this to tomorrow too but I just want to be clear –this is a decision letter on an employability assessment issue and the heart of the matter –the Board decided the worker could work as an insurance representative – and just at the top of page 2 – at the end of second line – "It is clear that you are currently suffering and that seems to be in italics – the actual loss of earnings in excess of the functional component of your worth however I am compelled to arrive at conclusions about suitable occupations that a worker could be expected to undertake in the long term future. The temporary loss of earnings pension cannot be granted." Now our concern there – the worker’s concern is there – the Board makes a decision that a job is suitable and available and to start off according to the Board – they have a loss of earnings but the Board says that loss of earnings is something they have to put up with. And the other way that we see this is that in the next 3 to 5 years there might be a loss of earnings but over the long term it won’t be. Shall I talk to this panel about that or wait until tomorrow?
A: I think it would be better if it is okay with you to wait until tomorrow in the context of pensions.
Q: With respect to employability assessments themselves and this is in your department and if not we can deal with it tomorrow – can you say that a parking lot attendant is still a viable job for workers to do anymore?
A: I don’t have any specific data on job availability but and I know the issues around the use of that particular occupation especially in deemed employability assessments. But rather than just focus on whether it is a parking lot attendant or Walmart Greeter or something of the other jobs that seem to be fairly – used fairly widely in employability assessments – I’d say we’d have to look at the individual worker – we have to look at the geographic area and we have to look at the availability information that is given to us at the time of the completion of the employability assessment. So if it is still viable? I’d say that probably in some circumstances yes.
Q: Well it used to be used as sort of if I may say so the bottom line –there wasn’t’ – the worker wasn’t unemployable but can in a parking lot attendant – it used to be that Labour Canada tracked that information and they don’t anymore because they have criteria for tracking availability of positions and it has to be so many vacancies in a period of time – they don’t track it anymore –if you start phoning around and indeed I think Mr. Gogg in your department produced a report on this –and that most parking lots are now automated and some of them have long seniorities and some of them are unionized so I – what you saying is that it is just one job the – your staff will look at?
A: Yes.
Q: All right – can you talk about the source of information for the calculation for rates of jobs that are used in employability assessments?
A: There are a number of different sources; perhaps I could get Mr. Hartmann to make some comments in this area? There are several sources including Statistics Canada Information that we can use, we also have the Board’s statistical information that we collect – when we are talking about employability assessments especially deemed we also expect that there be real employers contacted with real wage information given. When there’s a range – a wide range that’s between unionized and non-unionized environment we determine both ranges and be making the argument whether or not this person would fit the profile or of the availability of union versus non-unionized would be more appropriate. So in almost all cases we are looking at some form of real data that phoning around a random set of employers.
Q: And do you use – you use information from your statistical department?
A: Yes, our statistics keeps tracks and I’m not exactly sure how they extract or at what point but we do have statistics that we do have statistics that we use for a range. Usually when we are looking at more global statistics like that or things that are collected en masse we are looking for a range and then we canvas some real employers if they are fitting within that range and we can feel comfortable that we’re close.
Q: All right - on service providers and Mr. Hartmann I think this is your topic – you had a a list of costs – I – it was 1997 costs, correct?
A: Yes.
Q: And can you give us an idea of the costs say from 1994-97? – I gather they are going up?
A: With – it’s difficult to track because we have only recently separated out third party contract fees or funds expenditure to third parties under our Code T. Before Code T was implemented it formed part of our miscellaneous code which had anything that didn’t fit the sort of mainstream codes that we were using at the time; so it was really difficult to break that out, break it apart.
Q: Am I right that the amount of money spent on third party service providers is increasing?
A: Anecdotally I don’t know that I would agree with that. I think certainly in the years 1993/94/95 when case loads were much higher the time that individual rehabilitation consultants had spent on an individual case – there was more pressure there so I’m only making an hypothesis that it could be – that we used more at that time. But we don’t have the statistics broken down to be able to tell.
Q: You wouldn’t know if you were spending more, the same, or less then in previous years on third party, outside providers?
A: We don’t have exact figures to say that this the difference, no. That was one of the areas Mr. Steeves that I think that was identified again in the administrative inventory was the lack of accountability around the contracting out of vocational rehabilitation services in an effort to deal with that issue we added I believe it was 25 rehabilitation consultants to the department in early 1995 and we put very stringent approval mechanisms in place for the contracting out of services and we expect our own consultants to do most of the work themselves and only in the situations that Mr. Hartmann has outlined would they go to their managers for approval to contract out for services. We put written contracts in place now and when we put a provider network together we also measure outcomes from those particular third party contractors.
Q: Two issues on I guess issues relating to the contracts – one is privacy – what protection is there of the worker’s privacy with respect information passed on to third party service providers from the Board?
A: We must adhere of course to the Freedom of Information and Protection of Privacy Provisions. We try very hard to guard any privacy issues. The clients would be very much part of the process because we work collaboratively with them so we would always ask them to give us a release for the information that we are going to share.
Q: All right and is there a- sorry Mr. Hartmann.
A: I would just like to add to that that when we are using the third party providers we’re asking for specific services – the goals are usually outlined – the file doesn’t go – in very rare cases would the service provider be seeing the file or that kind of information – they would be seeing the information that is specific to the request. In some cases where such as vocational testing they may not have any of the information – we are asking for a set of standard tests that we then bring back and use them and continue to manage them.
Q: But some of your information – some of your providers have access to private information and indeed some of them generate private information –and is there a clause in the contract to require them to – about confidentiality?
A: I believe there is a clause in the contract which is consistent with our Freedom of Information and Protection of Privacy. I can only speak to the existing practice – which I implemented which was that Mr. Hurst is involved as Executive Director of Healthcare Services is involved in the negotiation and formalization of all contracts and he has – I think he indicated the other day – puts in every contract the requirement to respect the Freedom of Information – Privacy Legislation.
Q: The other issue about service providers is the question of about worker’s choice –as we know is section 21 in the statute – how do we accommodate the Board’s retention of outside providers and – that is the Board’s decision about who should be providing a service with the worker’s statutory right to choose their own treatment?
A: I think at this point we – the individual rehabilitation consultant is working with the client and in most cases the clients that we are working with wouldn’t have sufficient knowledge to identify appropriate service providers, however, in cases where we feel or they would like to have a choice there – I know there are examples where – we’ve even had the client meet with two or three or four of the providers to make a decision on who they would like to work with. That is done in some cases. There might appear to be a break down in the relationship with the provider we would certainly entertain having somebody else coming in in their place. Yes, those are all good answers and I think they address your concern but I don’t think the Board has ever – just to be clear – has ever interpreted that section 21 applies to – that there’s any choice of providers in the vocational rehabilitation area – I don’t think that is a correct interpretation.
Q: Yes, I think that’s right – it has to do with doctors.
A: Yes, yes.
Q: But some of your outside providers are doctors or are they retained doctors?
A: In the clinical arena, yes. You are right, there are doctors retained. But I think the reason I leaned over and suggested that Mr. Pinto clarify it is we have not taken the view that that particular section applies to choice of provider, however, when we h